Social Distancing and Beth March

“There are many Beths in the world, shy and quiet, sitting in corners till needed, and living for others so cheerfully that no one sees the sacrifices till the little cricket on the hearth stops chirping, and the sweet, sunshiny presence vanishes, leaving silence and shadow behind.”

Anyone who knows and loves the book Little Women knows the story of Beth. Beth is the third sister, quiet and shy, not quick to pour herself into social occasions like her younger sister, Amy. And though Beth is timid around a lot of people, she is quick to notice those who need help. Above all, Beth is kind.

The story begins at Christmas time. Beloved Marmee has gone to visit a poor neighbor family, huddled in one room with sick children. Later on in the story, when Marmee has to leave to go be with her wounded husband she charges her daughters to not forget this family. The only one of the sisters who remembers and is willing to go see them and care for them is Beth.

Beth ends up with scarlet fever, a disease that she caught directly from the family she had been assisting. It was an illness that we know now is untreated strep infection and includes a sore throat, high fever, and a bright, red rash that covers the body. For her kindness, she ends up teetering between life and death. The family desperate to see her well again, and she does recover from this initial illness. But scarlet fever can carry with it some residual damage, and she later dies from complications of the disease.

Does Beth’s kindness kill her?

History is full of people who die helping others. The “Chernobyl Three” who stepped into a radioactive area to drain a pool, and in doing so averted another explosion; Annalena Tonneli, who fought TB in the Horn of Africa and ended up killed by terrorists; Corrie Ten Boom whose family helped Jews escape by hiding them in their home – there are far too many to count.

We are in an unprecedented time in this century. A global pandemic has been announced and “social distancing” has been strongly advised. As a public health nurse, I agree with this approach. It slows down the spread of the virus, giving hospitals and health care workers opportunity to catch up and be able to treat those who are the sickest. But those health care workers – doctors, nurses, pharmacists, community health workers, physicians assistants, nursing assistants – they don’t have a choice. They work to keep the rest of us safe. They don’t have the luxury of “social distancing.” Some of them, inevitably, will get the virus. It’s the price they will pay for helping. My prayer is that they will not die, but will instead be cared for by people who are as kind and dedicated as they are.

Social distancing is something of a privilege – a privilege reserved for those who live in single family dwellings, a privilege for those who have the resources to stock up on many months worth of supplies. Millions around the world don’t necessarily have this privilege. Maybe we also need to rethink the phrase “social distancing” a public health term used to apply to actions that a health department deems necessary to slow the spread of disease. Could we change that phrase to physical distancing instead? Social distancing gives us room to ignore the other, caring only for ourselves, all in the name of containing a virus.

A culture, like the United States, that prides itself on individuality could happily distance themselves physically and socially, but maybe some of us need a little prodding to go help others. There may be a neighbor who is really suffering, and you may be the one to help them. There may be someone who needs a ride from the airport, and you need to go pick them up. There may be families that need you to not socially or physically distance yourself so that you can bring them food and supplies.

This social distancing may be the right thing for the majority of the population, but there may be some of us who will be called upon to give up that distancing and help others.

It will be easy, if that happens, to opt for fear, to use social distancing as an excuse. I’ve said it before in this space – fear is not good currency. Fear is more viral than the virus itself. There is, and will always be, something to fear.

In the past 24 hours, I’ve watched some of my family members and friends come together to help another part of our family who have been rerouted from their home in Thailand. They are tirelessly gathering clothes, food, a car, and other resources that this family needs. Any one of them could have said “No. We have our own families to care for, to feed, to stock up for.” None of them have done that – they have stepped up and they have stepped in. I am beyond grateful for this coming together, moving in to help instead of moving away.

Please hear me – I don’t advocate being foolish. I don’t advocate walking in to harm’s way just to be noble. But I do think there are times when we need to put others above ourselves, and in this country, we have a lot to learn about what that looks like.

Social distancing may be the kindest thing for some people; for others, we may have to step up and move in. May we recognize the humanity of the other more than ever. May we have wisdom on what is needed, and above all – may we fight fear and be kind.

And these thoughts from C.S. Lewis are apt, though written long ago:

It is perfectly ridiculous to go about whimpering and drawing long faces because the scientists have added one more chance of painful and premature death to a world which already bristled with such chances and in which death itself was not a chance at all, but a certainty.

CS Lewis

This is the first point to be made: and the first action to be taken is to pull ourselves together. If we are all going to be destroyed by an atomic bomb, let that bomb when it comes find us doing sensible and human things—praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts—not huddled together like frightened sheep and thinking about bombs. They may break our bodies (a microbe can do that) but they need not dominate our minds. CS Lewis on the atomic bomb

Fearfully & Wonderfully Body Scanned

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“Take off all of my clothes?” My voice intonates the last word as a question, rather like a child who asks her teacher if she has to complete all of the homework assignment.

I am sitting on an exam table under fluorescent lights in a clinic.  I feel cold, not only because it is an unseasonably cold April, but also because there is a deep loneliness associated with clinic visits and full body scans.

You lie naked as a stranger examines every bit of your skin. They concentrate on freckles, moles, and imperfections with frowns and furrowed brows. A magnifying glass assists them on the troubling areas and a computer helps them document what they see.

I feel an indignity as I wait, a feeling of vulnerability and loss. An indignity manifest in a naked body, the words of Adam and Eve reverberating through the centuries “I was naked and ashamed.”

I am acutely conscious of my own frailty and humanity during these times. I am astute at covering my imperfections, at dressing and acting my part in the world where I daily interact. But these moments erase all of that.

And yet, I have come here voluntarily. I have come here because I know that a short time of discomfort is far better than a diagnosis of a skin cancer. I know this well because a few years ago I was diagnosed with a skin cancer. Caught early, I now bear a beautiful scar, a war wound of sorts reminding me that scars are evidence of battles fought and souls made stronger.

We live in a world where our aging bodies betray us and tell a different story than the story that we feel. We watch as through the years people begin to respond to us differently. First, we are masters of the universe, we are young, and we are beautiful in our youth, even if we are not beautiful in our looks. We walk through this time with little thought to the older among us, or to the ones who have bodies that do not work as ours do. We may interact with a grandmother or a cute, elderly neighbor, but in our age-segregated society, we do not really know them. Out of embarrassment, discomfort, or just plain ignorance we avoid those who are trapped in bodies that do not function the same as ours do.

Then middle age comes along and the jokes begin. “Look how she’s aged” we whisper with giggles, certain that we don’t bear those same marks. But then, we catch sight of ourselves in car windows, and we wonder who we are and how we got so old, so fast. We continue to live, but the reflection that looked back at us from the car window showed us a reality that we would rather avoid.

And then the phone calls begin to come. One friend has had a heart attack; another friend is given four months to live when cancer is found throughout their body. Friends are diagnosed with diabetes and heart disease, arthritis, and cataracts. Funerals that used to be for others are now for us and ours.

We are eternal souls in temporary bodies that will need a new heaven and a new earth to redeem a broken process.

We still think we are immune – except for those now yearly physicals or body scans, where we lie naked before God and a stranger. Perhaps it is in those undignified moments that we realize that we aren’t so different from our friends. Then someday, the phone call will be about us. It’s in those times that we realize the reality of our humanity. Our scars, our freckles, and our moles on our earth suits are more pronounced, and we wonder how it will all end.

My faith tradition affirms that I am “fearfully and wonderfully made”.  And I don’t think that just means the young and able among us. Even as those who are fearfully and wonderfully made, we still need medical exams and physicals, body scans and preventive health checkups. We who are fearfully and wonderfully made need to brush our teeth and wash our bodies, eat healthy foods and exercise. In coming to earth in a human body, Jesus too was bound by his earth suit. He got hungry, tired, and dirty. He needed food, rest, and soap. He watched people get sick and die, and he didn’t heal all of them.

We are eternal souls in temporary bodies that will need a new heaven and a new earth to redeem a broken process.

How does one embrace every stage of life, appreciating what was and what is? How does one move gracefully through these seasons, putting trust in the Creator not the created; believing that there is something profoundly beautiful in our aging bodies? What does a theology of aging look like? What does holiness look like as I face my birthday and my body scan every year?

Before I have figured out the answers to those questions, the body scan is over. I am told that I don’t need to come back for another year. I am left alone with my body and my thoughts in a room that is still cold.

I get up and get dressed, inhaling a breath of thanksgiving. I am fearfully and wonderfully body scanned, and right now, that is enough.

Immigrant Families – A New Report

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Photo Credit: http://www.fhcw.org/en/Home

In the last two years, the immigration debate has become louder and arguably less civil. Political platforms and decisions based on fear have dominated the conversation, but behind the conversation are approximately 23 million people. The number includes those lawfully present as well as those who are undocumented. It includes around 12 million children who are legal citizens born in the United States, but whose parents are non-citizens.

How does the current climate affect the health and daily lives of these millions of people?

Kaiser Family Foundation wanted to find out more, and so began work with a research company to interview families in 8 cities in 4 states. They also interviewed pediatricians who work closely with immigrant families in these cities.

Their findings are significant and troubling. Among those findings are these:

  • Fears of deportation and overall uncertainty have increased in the last year. These fears extend to those who are here lawfully.

“I feel unsettled. Even though we already have the green card, if we do not apply for citizenship, I don’t think we can be at ease.” –Korean Parent, Chicago, Illinois

“Uncomfortable and unstable; we feel that in any moment a new rule could be issued leading to expelling us and sending us back.” –Arabic-speaking Parent, Anaheim, California

“There’s no stability. [The President] could write a tweet on Twitter tomorrow and turn things upside down.” –Arabic-speaking Parent, Anaheim, California

  • Children are facing increased fear that their parents will be deported and/or that they will end up having to uproot their lives and go to their parent’s countries.

“My children would come home from school and say that at school they were saying that all parents would be deported…” –Portuguese-speaking Parent, Chicago, Illinois

“All the children, even if they were born here, are fearful. They fear that anytime they’ll come back from school and won’t find their parents there.” –Latino Parent, Chicago, Illinois

“In Brownsville we have about 1,700 homeless children in the schools. Many of those children are homeless because of a parent that was deported or placed in detention.” –Pediatrician, Texas

  • Pediatricians and participants said that bullying and discrimination at work and at school has increased in the past year.

“They get bullied…told things like, ‘now you and your family will have to leave.’….And so, even though those kids don’t actually have to worry about their immigration status, I think obviously a child, they don’t know the details of how the system works.” –Pediatrician, Pennsylvania

“I work in landscaping, and we’re working and they see you working…and they just start yelling stuff at you…” –Latino Parent, Fresno, California

  • Families are making changes in their daily lives and routines base on fear.

 

“I am also concerned because if anything happens to us on the street, if we get assaulted or something, we won’t even be able to call the police because they will see we are immigrants.”      –Latino Parent, Boston, Massachusetts

“…but now around six or seven in the evening you won’t find anyone in [the neighborhood]… due to the fear we all feel about what is going to happen.” –Latino Parent, Chicago, Illinois

  • Increased fear in kids is resulting in behavioral issues, mental health problems, and psychosomatic symptoms.

“The kids who come in with concerns that you can kind of trace back to anxiety are usually the upper elementary age students, like the 3rd, 4th graders, to middle school students… 7th and 8th grade, who have nonspecific complaints like abnormal pain or headaches or decreased appetites… And then, in kids that are in the junior high to high school age range, it’s a little more overt: sadness, decreased appetite, not wanting to engage in usual activities, decreased in-school performance, those sorts of things.” –Pediatrician, Arkansas

  • Across the board, pediatricians are concerned with the long-term consequences of this environment.

“I think that we are going to have a generation of kids, who, especially in our immigrant homes, who are going to have more adverse childhood experiences than they would have. So, I think that we’re just setting up this generation of kids to have higher incidence of chronic disease, higher incidence of poor mental health, higher incidence of addiction…” –Pediatrician, California

“I think a huge worry is that children who have problems that are minor and fixable now… that, if those children go untreated, those could end up being bigger problems in the future that are going to be harder to treat and are really going to impact the child’s quality of life.” –Pediatrician, Pennsylvania


The health and well-being of immigrant and refugee communities is something I care deeply about. Yes, it is my daily work as a public health nurse, but it is more than that. It is something that is deeply embedded into who I am as a person. I have only benefitted from the many in my life who are immigrants and refugees, and it is troubling to me that there is documented fear and anxiety that is affecting the daily lives of those I care about.

What might we do to change this? What might we do to help those whose anxiety is affecting their health and the health of their families? The answer is bigger than any one of us, but some of the things that can help are these:

  • Know the law* and be able to point people to the law. Some of the fear is based on rumor. It is important to squash rumors and to point people to laws.
  • Sensitive locations. Both ICE (Immigration and customs enforcement) and CBP (Customs and Border Patrol) consider hospitals and other health care facilities to be “sensitive locations.” Both agencies have issued memoranda that say that immigration enforcement actions are to be avoided at sensitive locations, including at hospitals and other health care facilities, unless urgent circumstances exist or the officers conducting the actions have prior approval from certain officials within the enforcement agencies.
  • Right to remain silent. While immigration enforcement at health care facilities is limited by the “sensitive locations” guidance, immigration agents may enter a public area of a health care facility without a warrant or the facility’s consent and may question any person present, but those people have the right to remain silent.
  • Reassure your patients. Educate and reassure patients that their health care information is protected by federal and state laws.

An appeal to those of us who are Christians:

Caution and compassion are not incompatible; instead it is reasonable to assume that they work well together.  The state is not the master of the church. If you are part of a faith community, none of this prohibits you and your faith community from reaching out to those who may be affected. They do not prohibit you from reaching out, in love, to refugees and immigrants in your midst. It is a lot easier to wear a sign and yell than it is to make a hot meal and take it to strangers, to check in with sick neighbors, to pray for those who are anxious and fearful. We must be willing to do more than react emotionally. We must be willing to put our loudly voiced news feeds into real action.

“The ability to love refugees well doesn’t require a certain party affiliation. It doesn’t require you to vote a certain way. But it does require us to show up, to step across “enemy” lines, and to choose love over fear.” from Preemptive Love


*See this document for more information.

Note: Communicating Across Boundaries has never been, and never will be, a political blog, but I see this not as a political issue, but as a human health care issue. The brief is much longer and more detailed than this blog post. This post is simply to raise awareness of the issues that result from an environment of fear and anxiety.

Some Thoughts on Teen Pregnancy

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If you were giving a talk on teen pregnancy to a conservative, faith-based group who cares, what messages would you want to convey?

A couple of years ago I asked this question of someone in our family planning division at work. I was serious. I wanted her perspective. She did not hesitate.

I would tell them we live in a sex-saturated society, and everyone else is talking about sex – they need to be part of the conversation. I would tell them that you are not giving a teenager a mixed message if you tell them what you believe and what you would want them to do, and yet arm them with tools and knowledge about contraception if they make a different choice.”  It was a great conversation.

So armed with this, as well as facts and figures that tell more of the story of teen pregnancy I ended up leading a discussion at our church.

Along with the facts, I wanted to give a face to the story. I chose to show a clip from a documentary called “The Gloucester 18”.

In 2008 Gloucester, Massachusetts – a seaport city known for its lobster, fishing and The Perfect Storm found itself in the center of a world-wide media frenzy. Reporters from as far away as Australia and Brazil descended on the town with cameras,microphones and all the other apparatus needed for a sensational story. The reason?  There were four times the number of teen pregnancies than previous years and word had surfaced that 18 teenage girls had made a pact to become pregnant. As the nurse practitioner at Gloucester High School said “People love scandal”.

News networks preyed on this story like hawks and the girls and their families were deluged with phone calls from CNN to Dr. Phil.

So what is the real story behind these Gloucester teenagers? More importantly what’s the story behind teen pregnancy in general?

What we know:

We know several things. We know that teen pregnancy is a complicated issue and those that ignore the complexity are living in denial. “Just Don’t Do It” or teaching kids about sex by showing them Barbie and Ken in a shoe box seem to be  ineffective ways to deal with teens and sex, teens and pregnancy. While the United States has seen a significant decline in recent years, the lowest rate in 70 years, we still have the highest rate in the developing world, surpassing Great Britain, France, The Netherlands and Sweden.

We know other things as well….

  • that 50% of teen mothers get a high school diploma by age 22, compared with 90% of teen girls who do not give birth.
  • that teen childbearing costs U.S.taxpayers about $9 billion each year.
  • that girls born to teen mothers are about 30% more likely to become teen mothers themselves.
  • that children of teen parents are more likely to do poorly in school and to drop out of school
  • that half of teen pregnancies end up in abortion – if we care about abortion we need to face and care about the issue of teen pregnancy
  • that southern states have a higher rate of pregnancy than northern states
  • that less teens are having sex now then in 1988
  • that when money is put into sex education and birth control, the abortion rate goes down.

So when the discussion comes around to “Do we expect abstinence only programs to work in the world as we know it” I would say no. Any good sex education program has abstinence as a part of the curriculum, but the operative word is part not the entire curriculum.

Back to the Gloucester 18 – a face to the problem.  The truth is, there was no pact. There was no conspiracy to all get pregnant at the same time. Most of the girls found out about a pact by watching the nightly news. The stories portrayed are poignant and real. In the spirit of a good documentary there is a raw and compelling truth that comes through and you can’t stay detached through facts and figures because they now have names and faces and most of all, babies. Beyond the newspaper stories were kids having kids. Girls searching for meaning and purpose, girls looking for stability and love, girls trying to please boyfriends and parents, friends and school authorities. Girls who were still trying to grow up and ended up facing the task of motherhood and parenting.

God doesn’t force his boundaries on anyone; He may long for us to stay within them, but He doesn’t force us.

As much as I may want to wave my wand and make teenagers make different choices, I don’t have that ability. But I can understand the problem, present my view passionately and at the same time be willing to recognize the world we live in, a world we must respond to in ways that are wise. We live in a broken world, a world that is not as it should be. Our world is made up of people who have choices. God doesn’t force his boundaries on anyone; He may long for us to stay within them for our own protection, but He doesn’t force us. So what should my response be? Compassion? Common sense? Tough Love? Interest? All that and perhaps more? 

As I think about the issue of teen pregnancy and teen sexuality I think about sex as a china cup. A fragile, expensive china cup created by a Master Craftsman, with a unique and beautiful design. But once passed from the Craftsman to us to care for, the china cup broke into many pieces. And each of us try to put together these broken pieces, try to put back a pattern and restore a sense of what was.

Teen pregnancy is just one broken piece of the many. Can the Church be part of a solution to put it back together?

Note: This blog has been revised from a post written in 2012. I chose to repost because of the decision to cut millions of dollars from prevention programs.

The Full Time Job of Healing 


I am on medical leave. For the first time in many, many years I have time. I am not moving. I am not job hunting. I am not on limited vacation time. Instead, my full time job right now is to heal. 

It is one of the hardest jobs I’ve ever done. 

Here’s why: 

  1. Healing takes discipline. It takes discipline to set aside time for physical therapy. It takes discipline to eat properly, discipline to not just veg out and binge on television shows. It takes effort to get up in the morning when you hurt, discipline to put your feet on the ground. I am not disciplined and at heart, I’m pretty lazy. I would far rather have a quick fix then a slow, steady process. But healing has its own agenda and schedule., and it demands discipline. 
  2. Healing takes rest. So much of physical and emotional healing is about resting. And true resting is when both your body and soul are at rest. I find myself trying to rest, but my mind buzzes anxiously with thoughts about what I think I should be doing, how I think I should be reacting. Rest is uncommon in the Northeast. Instead, what is applauded is achievement, academic success, graduating from top schools, busy and successful career paths. Rest is something that we don’t talk about or give permission for, instead opting to glorify busy. But healing demands rest. Our bodies have undergone trauma – whether it be from surgery, from illness, or from an accident. The body’s needs for rest increase. Our bodies also need proper nutrition to augment the rest. 
  3. Healing takes humility. Giving up control is hard. Having to have others help you dress, bathe, cook, drive, clean, even put on your shoes is deeply humbling. Actively watching out for self-pity is also humbling. It’s easy to clothe self-pity into “well I’m just being honest about how I feel..” But at the end of the day, it’s still self-pity. It takes humility to follow the guidelines and restrictions of others, to trust medical personnel. It takes humility to allow strangers into your home to see how you live, and to give you suggestions and ideas of how to live better. It takes humility to accept that healing doesn’t happen on the timeline we request. It takes humility to respond to questions about our bodies, to use assistive devices when we go out the door. 
  4. Healing takes time. Above all, this is true.  Neither physical nor emotional healing comes quickly. Instead it’s a long journey.  Yes, there are things we can do to heal as quickly as possible, but ultimately it still takes time. 

And so I have time – and my only job during this time is to heal. 

Years ago, I listened to a recording of a woman who spoke on suffering. It was a powerful talk and I probably listened to it over fifty times in the course of the next few years. One of the many things she said was this: 

Our churches are full of wounded and hurting people who have never taken a season to heal. 

These words are profoundly true – true for the ones who need physical healing, true for the ones who need emotional healing. 

So I will not fight this season, nor will I wish it away. Instead, I gratefully accept my season to heal, and the gift of time. 

Hospital Time


I’ve woken early today. Only the birds sing outside, alerting me that it is spring. 

I have been on hospital time since Friday. It’s a strange, twilight time where what we think of as important vanishes, in its place comes a subdued submission to all of life. 

Hospital time is well-known to many – the cancer patient going for weekly chemotherapy; the dialysis patient praying for a kidney; the family of the child in an accident, an induced coma taking the child away for a time. 

Hospital time is part of the human experience, a definite part of aging. We are seen by doctors, recommended to surgeons, and humbly, like sheep being led, go to classes and appointments, lest we be the .3% who doesn’t do well. 

On Friday last week I entered into hospital time. I had a 3-week lead time, so in a sense, hospital time came on slowly, incrementally. 

But on Friday, it was real. Friday I was stripped of my normal identity and became a woman who was being prepared for surgery. With the signing of my paperwork, hospital time began. 

Outside, the world rushed on. Social media erupted over something, the stock market rose and fell, news stations put their overly dramatic news teams onto things both menial and important. 

But none of that mattered. What mattered was hospital time. 

When I think about Eternity, I think about hospital time redeemed; a time when all creation is healed and time surrenders to the Creator. No longer are our moments filled with rage at injustice, fear of the unknown, sadness of loss, or worry about the millions of things that are out of our control. Because time is redeemed and reconciled to our creator. 

In the meantime, I am still in my other world of hospital time, taking the moments to heal and rest, realizing that life will go on without me at its center. And in this time, I am enveloped in grace. 


Readers- I would love it if you entered this book giveaway for Passages Through Pakistan at Goodreads! 

Enter here! 

On Vanity and “Skiing Accidents”


“I think surgery is the best, maybe only, option.” 

I’m not surprised to hear these words from the surgeon sitting across from me. Aside from his appearance (he looks like he is 12) I think I trust him. I did the google on him, and evidently his competent 12 year old hands and brain have a brilliant success rate. 

For months now I have had increasing pain in my hip. When treatments, physical therapy, and sheer grit did not work, I decided to see a surgeon. 

So I find myself sitting across from a stranger who is showing me an X-ray of my hip. What I see is not pretty. 

“Can I tell people it’s a skiing accident?” I ask. I think I whined, but I can’t remember. He laughs. He thinks I’m joking. 

But my pride is hurt. My vanity is wounded. I feel far too young to have a hip replacement, especially when I can blame it on nothing but arthritis. If only I was an athlete – a runner, a skier, an aerobics instructor! 

I am none of these things. 

I am a 57 year old woman with arthritis. 

Just saying it makes me want to curl up in dismay. 

Secretly, I think we all believe that aging is for other people, not for us. We secretly remark on how “grey and wrinkled so and so is getting,” while in the mirror the wrinkles hide under the perfect make up foundation – denial. 

Denial paints our bodies and skin in the flawless glow of youth, even as we marvel at the years weighing others down. 

Aging is not for the timid, not for the fearful, and I fear I am both. 

In late February I visited my parents in Florida. Though they live in Rochester, New York, they have tried to get away for a couple of months the last few winters. Rochester is cold, snowy, and icy. It’s a fall waiting to happen and the prospect of warmer weather drew them to warmer climates. So at the end of February I found myself visiting them in Panama City Beach.

This area is known for its incredible turquoise water and white sand. The contrast is stunning. Along with this contrast is the contrast between the young and beautiful and the snow bird aging population. 

The weekend did not turn out the way we expected, but we still deeply enjoyed each other’s company.  As I looked with eyes of love on my parents I realized that I don’t like the aging process. But as I watched them, I recognized that I am not afraid for them – I’m afraid for me. I don’t have the kind of stamina and courage they do. I don’t have the faith that they do. I am not brave. I do not want to age.

It is a relief to admit this. I do not want to age. It’s not about the wrinkles, though they are tough. It’s about the body. 

Aging is hard work, and I am lazy. Aging is for the courageous, and I am not. 

I don’t feel sorry for my parents. They have taken all the changes with incredible grace. Their minds are alert and active. They live independently. They take their pills with discipline and a good deal of humor and grace. 

I feel sorry for me – because I clearly have some things to learn about life and the body, and I better learn them quickly. 
Perhaps being honest about this surgery is my first step. Perhaps admitting publicly that I am vain, that I have to have a hip replacement, and that it is NOT because of a skiing accident, or a marathon run, or a heroic act of physical courage is the best first step. 

I wake up this morning and I take off the make up of denial, and I pray for courage and strength to face a reality that every human being who lives longer than 50 has to face: The reality of aging. 

But I still may tell people that it’s because of a skiiing accident….,

Dear Seema: The Politics of Prevention

 

Note: Seema Verma is President Trump’s nominee to lead the Centers for Medicare and Medicaid Services in the United States.

Dear Seema,

I’m a Registered Nurse who works in Boston, Massachusetts. I have witnessed first-hand what it is like for people to go without insurance, to delay preventive health screening only to find out that cancer is a far more expensive problem.

There are not a lot of things that make my proverbial blood boil, but reducing access to preventive healthcare, including maternity benefits, does. It makes me so angry I can’t see straight.

Look, I get it. Health care is expensive. Someone has to pay for it. But everyone bears the burden of an unhealthy society and while the Affordable Care Act (aka Obama Care) was not perfect, it began to put some policies in place that have been needed for a long time.

I come to this not from any political party line. I am a proudly independent voter – in fact, prouder by the day that I don’t buy into that assanine system called “two party.” I also live in Massachusetts where a Republican governor put health care reform as a top priority over 8 years ago and we are slowly reaping the benefits.

 

When, at your confirmation hearing, you mentioned that coverage for maternity benefits should be optional, I shook my head in disbelief.

Optional? Optional? I had to repeat it to myself to believe that you actually said it. The argument goes that if you’re a man or too old to get pregnant, then why should you have to pay for someone to have a baby? The lack of logic and understanding in that idea astounds me! The logical conclusion is that I shouldn’t have to pay for any of the choices that others make. So, by your logic, I shouldn’t have to pay for the business man who has a heart attack and needs bypass surgery. After all, I wasn’t the one who ate and drank too much. It was him.

Maternity benefits are an essential part of a healthy society. Maternity benefits speak to the value of family and children, they provide essential care for a future generation.

As Linda Blumberg, a senior fellow at the Health Policy Center at the Urban Institute. Women says: “We buy insurance for uncertainty and to spread the costs of care across a broad population so that when something comes up, that person has adequate coverage to meet their needs,”  But insurance is not designed to be an  “a la carte approach”. “Women don’t need prostate cancer screening, but they pay for the coverage anyway.”

When as a nation did we allow politics to co-opt our health, to feed us misinformation about insurance and that terror-producing term ‘socialized medicine’? Truth is the term ‘socialized medicine’ is a made up phrase. It was first heard in the early 1900’s but came into wide use when the American Medical Association fought against a national health insurance plan proposed by President Truman. It conjured images of a hammer and sickle approach to health care that would lead us down the slippery slope to communism. That was in 1947 – and it was a public relations coup, for in the six and a half decades since that time we have allowed the term to rule us, to be thrown around willy nilly to produce fear and anger, obnoxious and ignorant voices leading the way.

Here’s what happens when you let politics coopt prevention: 

A breast cancer lump ulcerates and eats away the flesh of a breast; a cervical lesion, easily removed, grows and turns into a completely preventable cancer; a gnawing indigestion and bloated feeling turns into cancer eating away at your colon – fully preventable had screening taken place early in the disease process. You know what else happens when politics coopts prevention? Abortion rates, already far too high, go up. You can’t have it both ways – you can’t want abortion rates to go down and yet reject the notion of maternity care and birth control coverage.

Preventive health is not about being Republican or Democrat or Independent or Green Party or Libertarian. Preventive health is about the health of a society as a whole; it is about being human, living in a broken world where illness and death and “pre-existing” conditions are a reality. Preventive health and being sick is not about politics. When will we in the United States get that?

What you should want to do in your tenure is make the Affordable Care Act better! You should want to expand on it and leave a legacy that puts Obama Care into the water. You should want to make a name for yourself as a person who makes health care great, not just tolerable.

Instead, I’m shaking my head and saying: “What in the name of Sam Hill is she thinking?” 

C’mon Seema! Be a Woman. Stand up for what is right. 

 

Loneliness and the Jesus Prayer 

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I lay on my back in a sterile room, a fancy xray machine above and around me. I am with complete strangers, entrusting myself to their care and expertise. The burgundy hospital gown I wear is a shapeless piece of cloth, fashioned not for beauty but for practicality.

I am alone and I feel vulnerable. While I trust the strangers in the work they do, they know nothing about me other than my name, my age, and my insurance carrier. Other than that, I am an anonymous body in a big system.

They don’t know that I woke up this morning thinking about my beautiful grandson and the daughter who is his mom; they don’t know that I am thinking about my parents and how aging is not for the weak, not for cowards. They have no idea that I have five children whom I would give my life for; that not a day goes by without me thinking about them and praying for their hearts and souls.

They know nothing about me beyond this procedure.

These strangers are kind, they try and make me as comfortable as possible. They explain every step of what they will do and try and buoy me with their confidence.

In the big scheme of things, this whole procedure is small. The pain is nothing in comparison to other pain that I’ve felt. It’s just that the feelings it evokes are big.

Somehow, it feels like this pain represents the pain of my world, the pain that so many I know are experiencing. It represents physical and emotional pain. It represents the deep loneliness that many live in every day. It represents the isolation within which so many live and die.

Sociologists claim that social isolation is now endemic in American society. The number of adults who claim they are lonely is double what it was in the 1980s. This affects the overall health and wellbeing of millions of people. Both physical and emotional pain are intensified by loneliness. We are hard-wired for human connection and when that is missing, we suffer.

All this I think about as I lay, watching a stranger busily prepare for a medical procedure.

I’m alone in the room now. They say they will be back soon. The Jesus Prayer is on my lips: Lord Jesus Christ, Son of God, have mercy on me, a sinner. 

There is something about this prayer, something that reminds me that all this loneliness and pain I am feeling for the world is not my burden to bear. It is too big and it would quite literally kill me. I slowly release it, offering it up to the unseen but fully present God that I trust.

Lord Jesus Christ, Son of God, Have Mercy on me. And so it is.

Dear Primary Care Provider…

Dear Primary Care Provider: 
I’ve wanted to write this letter for a long time, but never took the time. But after a morning coffee conversation with my 23-year-old daughter, I knew that I owed it to her and to the rest of the United States to write what I’ve seen, write what I know.

Because we’re frustrated. And it’s not your fault, but you are the face of medicine today. So I have a few things I want to say, and I’d like you to communicate these to your colleagues in specialty practices, to your staff, to your former professors, and to your administrators. Thank you ahead of time for listening.

  1. We don’t understand your language. You speak Doctor, and we speak The People. The dialects are completely different. We are smart and successful– but we don’t know what the heck you are saying. So train yourselves to speak with the people, not AT the people.
  2. We are so intimidated by you. Really. You frighten us. You come from a culture that is so rigid and inflexible – that would be the culture of western biomedicine – and we don’t know this culture. And your staff can be the worst. Pick your receptionists, medical assistants, and nurses carefully. Because they can make people feel so stupid and small.
  3. Our bodies sometimes scare us. Look, you study the body for a living. For most of us, high school biology was a long time ago.
  4. When we express something that feels important to us, we often feel dismissed. It’s a horrible feeling to have our vulnerability met by nonchalance. We need you to see the person behind the words; to hear the story beyond the symptoms.
  5. On that same note, I think you expect us to know more about our bodies than we do. We don’t. That’s why we come to you.
  6. Please ask us to repeat back what you have told us. That gives both of us an opportunity to clarify misunderstandings.
  7. We know you aren’t our friends, but we do talk about you at parties. We rave about you if you are good, and we tell people to steer clear if you aren’t. We are your best advertisments. All we ask is that in return you treat us with dignity and respect, and sometimes we feel like it’s missing.
  8. A little empathy goes a long way. And I think in the long run, you will realize that our visits will be shorter if you can express that empathy. I suggest you read The Empathy Exams and The Spirit Catches You and You Fall Down. 
  9. Culture matters. We view illness and health through a cultural lens. If you don’t get that, then you will fail as a true physician.
  10. After we leave you, we fight with our insurance providers. Because the fact is, the Affordable Care Act did not fix a broken system. It merely provided a bandaid. So two weeks after we see you, we usually get a bill. And that’s why we don’t keep follow up appointments. Because insurance is a multi billion dollar industry, and we can both agree that it runs healthcare.

We appreciate you and the work you have put into your education and our appointments. But we need you to know these things so that you don’t lose us.

Sincerely,

A patient, a nurse, and a mom.

PS – please teach your staff how to take blood pressures properly….just sayin’….

Raccoons, Tigers, and Okapis and How Where You Live Matters

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“Pooling people in race silos is akin to zoologists grouping raccoons, tigers, and okapis on the basis that they are all stripey.” from Genes Don’t Cause Racical Disparities, Society Does

An article from The Atlantic, as quoted above, says this “Researchers are looking in the wrong place: White people live longer not because of their DNA but because of inequality.”

It’s NOT about race people! 

Basically, billions of dollars have gone into funding studies that look at race as a basis for health disparities when, in fact, it is far more about living conditions. For years conventional wisdom has argued that there is really nothing we can do about these health disparities, because it’s really about biology. But a review of the literature showed none of that. Jay Kaufman, lead author of the study “The Contribution of Genomic Research to Explaining Racial Disparities in Cardiovascular Disease: A Systematic Review” says this:

“If you show that this is a predisposition that is genetically determined—black people just have this gene, there’s nothing we can do about it, this is just nature—then society is completely absolved. We don’t have any responsibility to solve this problem….If you show that it is because of racism and injustice and people’s living conditions, well, then, there is some responsibility and we have to do something about this.”

One of the things that we pay a lot of attention to in public health is something called the “social determinants of health.” The social determinants of health are defined as “the conditions in which people are born, grow, live, work and age, including the health system.” This takes into account not only your genetic code, but also your zip code.

Here is an example: Four years ago I did some consulting work in Washington state for community health workers. One of the classes that I held was in a public housing space in Tacoma, Washington. The space was beautiful. It was a ‘mixed use housing’ area which means that some people owned their homes while others rented. There was a beautiful playground, a clinic, an assisted living space, and a school down the road. But when I asked someone who lived there where residents purchased food, she looked at me and said “It takes three different bus rides to get to a grocery store.” This is what we call a “food desert.” Right across the street you could buy 1500 calories of junk for a dollar and yet it took a major part of the day to buy good food.

A researcher who goes into that community, a community largely made up of “people of color,” may find high rates of heart disease. But it has little to do with the color of their skin, and perhaps a lot to do with the fact that healthy food is so far away.

All of us, regardless of our station in life, interact with the world around us. And it is in this world that our health is created. So if we live in a neighborhood that has clean air, wide sidewalks, well-lit streets and play grounds, along with affordable farmers markets for fruit and vegetables, we have a far better chance at health than the person who has none of these things. Turns out that person is far more likely to struggle with asthma, lack of physical activity, obesity and poor nutrition. It also turns out that most of “those people” end up being people of color.

Where we live matters! 

In the PBS series “Is Inequality Making us Sick?” questions about the social determinants of health are asked. Like the article in The Atlantic, the answers are troubling, because it’s a lot more to do with our neighborhoods and zip codes than our genetic codes. And that means we can do something about it.

All of this is best summed up in this statement:

“When it comes to why many black people die earlier than white people in the U.S., Kaufman and his colleagues show we’ve been looking for answers in the wrong places: We shouldn’t be looking in the twists of the double helix, but the grinding inequality of the environment.”

But, like almost everything, it is far easier to write about it, then to take concrete action and actually do something about it.

Cross-cultural Connection

Recently I went to an outreach center in a different part of the city, a few blocks from the subway and behind the mosque in Roxbury. This area is perhaps the most diverse area in Boston. Here people from all over the world find their homes in apartments and houses. Residents are from Somalia, The Sudan, Ethiopia, Iraq, Senegal, Nigeria, Ghana and many more places. A large community health center in the middle of the community attempts to meet a myriad of health and social needs of residents.

We have tried to outreach to this community with health education for about a year and a half. We partner with a community based organization who are part of the community and committed to working within to make it a healthier and better place to live. I love this group. They are smart and funny. They work hard to create safe places where health messages can be heard and understood.

Tuesday was a breast health education session delivered to Somali women. They were all over 50 years old so in the age range where the majority of breast cancer cases are found to occur. Through interpreters and funny stories, poignant re-telling of hard events and sharing of different cultural beliefs we went through the session page by page. Time stopped as we gathered in a hot room talking, listening, learning. Between trainers, attendees, and a colleague we were from Nigeria, Ghana, Ethiopia, Eritrea, Somalia, and America.

This is where I learn why certain myths about breast cancer exist – for they don’t come out of mid-air, rather they are based in stories and events. This is where I learn that the women present believe that trauma to the breast causes breast cancer. “We come from a place where there is war” says one. “And the soldiers take their guns and hit us in the breast to keep us moving. Then we get breast cancer.” We talk about this and I’m not sure how far we get. It will take more conversations, more events, more relationship building to convince them that this is not founded on fact, on evidence, but on story.

This is a world I love. A world where interpreters and native speakers gather with others and connect over a common cause. A world where it doesn’t matter that the session was supposed to take 45 minutes and it took an hour and a half. A world of women from different cultural backgrounds, where I in my western clothing and they in their Somali clothing, head scarves wrapped tight, could begin the long dialogue of understanding. A world where skin color varies from pale cream to glowing, dark brown and every shade between.This is a world that resonates soul deep. My heart was full of the joy of connection and belonging. This is a world I know. A world I love.

It’s times like these that the early mornings and occasional mediocre days of the working world fade into the background, gloriously overshadowed by cross-cultural connection and with this, contentment.

Readers – I want to connect you to an amazing resource today! A friend of mine from years past has started a service called Kids Books Without Borders. Gail grew up overseas in France with a British mom and an American dad. And she loved to read! She has collected over 2000 books! 2000 BOOKS!!! And she now extends this love of reading and books to those who live overseas. All she asks is that you pay the postage. This is what Gail says:

Does your family live overseas and enjoy reading?  I have collected over 2000 books, available to you. I will send you a box of books to a US address or directly to you overseas.  All books are free. If shipped in the US, postage is also free.  If shipped overseas, I ask that you pay half the postage. Check out my website and submit a request.  I will then send you my booklist, so you and your family can shop!  

Think Christmas! Think Books! And then contact Gail at kidsbookswithoutborders.wordpress.com

From Skin Check to Confession

A couple of years ago I was diagnosed with melanoma and after a biopsy and surgery I fell into the routine of regular full body skin checks or scans. My “melanoma check” was a bit over a week ago on a Friday.  I had my day all planned. I would go to my appointment, then pick up a cup of coffee, and then head to meet Father Patrick for confession.

As I waited at the desk of the receptionist I looked around me. It was early in the morning but already the waiting area was full. Every age, every color, every size, every gender, every income level.

I quickly checked in and looked around again. There was the teenager, his face scarred with acne, a mom hovering beside him dancing the awkward dance of concern and nonchalance. If scars could speak they would probably tell a story of merciless teasing by clear-skinned kids who knew how to make life miserable for one who already suffered. There was the older couple, he with a bandage over a part of his face, perhaps a result of skin surgery. And there were so many more, all of us with our imperfect skin, there to be checked over by a specialist who knew just which imperfections we should be worried about.

This yearly visit is fairly painless other than the humbling experience of having my naked body in all its wrinkled, spotted glory fully exposed to fine specimens of young male residents (where are the females in dermatology I ask you?) A resident goes over my body with a magnifying glass. Anything suspicious they swab with alcohol and take a closer look. All the while they are talking to me and asking me questions about my skin. Do you wear sunscreen? Any history of cancer? Any history of melanoma or other skin diseases? And then statements – Ah – looks like you didn’t wear sunscreen here! It’s a bit like a dentist asking me if I floss.

All I am to these physicians is a body with a skin disease. Nothing else. I am not a wife or a mom; an employee or a friend; a nurse or a trainer; most certainly not an author. It’s immaterial to them – what matters is my body, separate from my soul, my heart, and my mind. The Big Doctor comes into the room toward the end of the visit and the residents are clearly in slight awe of him. He talks about me in the third person and turns out the lights holding a black light over my leg, focusing on the four-inch diagonal scar where the melanoma first presented. See he says see you can really visualize all her sun spots here. This is called “solar lentigo” he launches into the technical name for the white sunspots that are now gleaming like stars in a dark night on my skin. For a moment I separate myself from my body as well and look down on my legs like they are a foreign thing, unattached to my person.

And then we’re done. All set. No need to come back for another year unless you see something that is cause for concern. Out the entourage goes. The residents (who incidentally looked like they were 12 years old) off to check another body.

And as I began dressing I thought about where I was going next and the juxtaposition of these two visits. From skin checks to confession. One interested only in my body, the other primarily interested in my soul, yet cognizant of the role body, soul, and spirit play in our personhood. One concerned only at that moment, the memory of my skin fading as quickly as a door closing and opening to the next patient; the other concerned on an ongoing basis – concerned with my outward roles as mom, wife, and more, but more so my inner being – my soul.

At the first visit a resident is equipped with a magnifying glass and a black light, at the second there will be no magnifying glass other than the eyes of God, there will be no black light, there will be no talk about me in the third person. It is my choice to reveal that which I want to reveal.

I am leaving a place where I am a specimen and entering a space where, as a human being created in the image of God, I have inherent worth. At one there is a Big Doctor, a specialist known worldwide, his residents trying to please at every turn.At the other – a priest relies on the Great Physician, the one who heals body and soul.The contrast has me shaking my head in consternation and amazement.

From skin check to confession. Both important but one infinitely more so. I check out of the office leaving with an appointment scheduled a year away and head to confession. My body is okay. My soul still needs checking.

And Then I Slept

Emerson Inn quote

On Saturday evening my head was pounding and I felt half present, the result of a summer cold that hit me hard and knocked me down. It was a lovely holiday, filled with friends, family, activity, food, and games. But the stress on my body from lack of sleep and busy work and home schedules caught up with me.

So at 9pm, suddenly alone, I found myself sobbing. It all felt too much. I felt inadequate, I felt weak, most of all I felt tired. The whole world seemed upside down. And then I slept.

It is amazing how my perspective can change after a good sleep. 

One of the things I love about the Psalms is how they speak to human need, whether it be fear, depression, hunger, thirst, or sleep. The Psalmist is unafraid to voice his honest thoughts to God in the form of beautiful poetry. And Psalm 3:5 speaks to the perspective offered after a good night’s sleep:

I lie down and sleep;
    I wake again, because the Lord sustains me.

We have bodies that function best when they are cared for. Cared for in the proper sense, with healthy foods, exercise, and adequate sleep. And so many places in my faith tradition point to a God who understands our humanity, sees the complete picture. From offering breakfast on the banks of the Lake of Galilee to feeding a massive crowd who was growing hungry, we see he meets the needs of the whole person, takes into account our human frailty. And so it should be with me, understanding the person as a whole, changing my care to take into account tired bodies and worn souls.

How are you frail today? Where do you need a God who will offer you rest? Where do you need a friend who will walk beside you offering tea and hope in the journey? 

Finding My Niche in Public Health – What I Do in My Day Job

I don’t often talk about what I do – like my paycheck job, the job that pays for food, rent, and children’s college tuition. But today, because it is my biggest and busiest day of the year, I want to talk about what I do. Because I have found my niche — as a nurse in public health working with patient navigators and community health workers.

I have always loved that I am a nurse. I have always worn the title RN or Registered Nurse with deep pride. First because I couldn’t believe I actually made it through school;second because I love the profession. It challenges my weaknesses and gives voice to my strengths.

But though I have always loved being a nurse, I’ve not always been a good nurse. There was the fear factor that I would do something wrong in my early days, there was an insecurity in my skill set, a sense that I still didn’t really know where I fit as a nurse.

While living overseas in Pakistan and Egypt I worked sporadically – private duty cases, teaching childbirth education, and accompanying women during labor and childbirth.

When we moved to the United States I began working as a visiting nurse, going into homes and caring for patients who had just been released from the hospital. I was restless. I knew that clinical nursing was only half the picture of what I wanted to be doing.

It was during that time I made a job change and discovered public health. Public health allowed me to use my clinical skills as well as my creativity in developing programs and presentations to use in communities. I learned more about the big picture of health and why it matters. It allowed me to focus on underserved communities, communities that don’t have as many resources like immigrant and refugee communities, like poor minority communities. I began to understand more about working with people who have the greatest need and where, with the least amount of money, you can make the biggest impact. I ended up specifically working in preventative health screening – breast, cervical, colorectal, and prostate screening. Connecting patients to doctors and clinics so that instead of waiting until a cancer lump grew and the cancer spread, the patient would be screened early; so that instead of coping with chemotherapy and drastic life changes, they would have a minor procedure.

I found my niche in a space where I began educating community health workers and patient navigators, helping them see their natural abilities as valuable and adding clinical knowledge and other skills so they could work in their own communities and effect change. These men and women were bilingual and multicultural, but often without opportunities for higher education they struggled to find a place where those skills mattered.  They are from all over the world and had made their way by various paths to the United States. They hail from Spain and Brazil, Portugal and Dominican Republic; Puerto Rico and China; Bangladesh and Somalia; the Sudan and Haiti. And they are finding their own niche in a country that is far different from the countries and places where most of them grew up.

So today we hold a conference that allows these patient navigators and community health workers to come together and learn, to come together and present what they are doing, to come together and be celebrated, to realize that they are a valuable part of our health care system.

But back to the niche – an amazing thing has happened through this process. I realize that the skills of communicating and negotiating across cultures are used regularly in this job. Those skills I felt would lie dormant and not be used again now allow me to build relationships and connections, encourage and voice understanding of the experiences of both patients and community health workers. Because all of us are outsiders that have gone through the process of adjusting to an unfamiliar world, working to carve out a niche where we can use who we are to make a small difference in the lives of some of the most vulnerable in our communities. 

If you are interested in hearing from some of the people I work with about the amazing work they do take a look at this video that we are showing today at the conference. It’s about 8 minutes long and includes both animation and stories from the community health workers. It was created by my son, Micah.

 

On Polio (and When it’s all too Much to Bear)

None - This image is in the public domain and ...

Afghanistan – where war, Taliban, drones and mudslides keep this country of hospitality, amazing people and amazing food on its knees and in its cemeteries. And as if this country has not had enough to contend with, a little girl sits on the floor in her home made of brick and mud suffering from polio.

Sometimes it’s just too much to bear.

Polio was near eradicated. For 25 years the World Health Organization promoted an aggressive world-wide vaccination campaign. The oral polio vaccine is simple – a couple of flavored pink drops at 2 month intervals and then a final booster dose a few years later, 4 doses in all. It doesn’t hurt. It’s safe. And it works. 

Here’s a bit about polio*: It loves hot weather, thriving in conditions that kill other viruses. Although it’s primarily in children it can be spread through others, through porous borders, through trade. It lives in the throat and the intestinal tract and is spread person to person. It is spread through oral secretions and through the feces of the infected person, so in places where the sewer systems are inadequate — refugee camps, poor villages, places where many people are living in close quarters without proper bathroom facilities. Already this year, a couple of months before the true hot season has begun there are 68 cases reported worldwide. While that seems miniscule compared to the billions of people in the world, last year at this time the numbers were about a third of this. And of those 68, 54 of them come from Pakistan.

But Syria too is in trouble. Prior to the war (or uprising because uprising perhaps caters to our prim sensibilities, but let’s be honest – it’s a war) the vaccination rate of Syria was high, upwards of 90%. But that has fallen dramatically and the first case of polio in years was reported this past year.

Vaccinations and vaccinators are suspect in Pakistan, the part of the world where most of these cases have emerged. At one time the CIA launched an undercover mission, using vaccination camps as their cover. Since that time any vaccination program is suspect.

So now polio has spread to Afghanistan, and a little girl sits on the floor. The New York Times reports that it is the first confirmed case in the capital of Afghanistan in 12 years.

Sometimes it’s too much to bear. 

Too much to try to make sense of all this. I thought yesterday was bad as I was reminded that over 200 Nigerian school girls were kidnapped by an extreme Islamic group and we all finally began to pay attention, signing petitions and using hashtags because we felt so helpless and knew we could do nothing else. And then today I’m reminded of polio and its devastating effects.

What do you do when it’s too much to bear? When you work in a grey cubicle and your heart hurts? When you want to point a finger but you know three will point back at you? What do you do when you try to figure out how you can in one breath be raging about Nigerian girls and in the next be excited about a television show that keeps you captivated for two hours? When you realize your own inadequacy in everything but that which you are directly responsible for – and even then, you often feel inadequate?

What do you do when it’s too much to bear? You put your head down and pray so deeply it hurts. And then you go to work doing what you know you’re called to do for the day, because you are not the Saviour, you are only the saved and that by grace alone. 

*For more on polio see the CDC website: http://www.cdc.gov/VACCINes/vpd-vac/polio/default.htm

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The Reluctant Orthodox – Volume 26 “On Midwives and Confession”

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I wait on a side pew with several others. Vespers and vigil have ended and most of us are sitting in silence. In the far left corner of the sanctuary our priest sits with someone. We sit and wait, none of us impatient.

Like a waiting room in a doctor’s office, each of us come with our own particular needs, pains, sorrows.

My mind travels back to Chicago and my pregnancy with my firstborn. I didn’t yet know that it would be a baby girl and that we would name her Annie. I sit in the small waiting room of a midwifery practice. The room is full, all of us at various stages of pregnancy, some of us accompanied by husbands, mothers, or others. We sit and wait, none of us impatient. Because each of us know that when our turn comes the midwife we are waiting for will have eyes and ears only for us. We will be her focus, our problems and pregnancies the only thing that matters right then. The midwife will examine each one of us with care, checking the heart beat of the baby, measuring our expanding bellies to make sure our babies are growing properly. At times she will ask a question, at times she will give advice or a warning. We are all grateful for this midwife. She is amazing and gifted. We wouldn’t think of going through an important time like pregnancy without her.

When we leave we are encouraged and comforted, moving forward and resolving to have as healthy a pregnancy as possible. And each of us will return, not at the same time intervals — some will come in a week, some in two weeks, some in a month. But we will all return.

Somehow this waiting in the church feels similar to the waiting for the midwife. We are waiting for confession. None of us impatient because we know when it’s our turn we will have the undivided attention of a priest who is called to walk with us through this spiritual journey. He will listen to us, ask an occasional question, at times give advice or a warning. Like a waiting room in the midwife practice, each of us come with our own particular confessions, needs, pains, sorrows.

Confession in the Orthodox Church is not about confessing so a priest will forgive you. The belief is that no one can forgive but God. The priest serves as witness to the confession. So we confess our sins to God with the priest present. He in turn gives advice, counsel, or encouragement. We live in a society where self-help, advice columns, and ‘bettering oneself’ are daily topics of writers, pop psychologists and motivational speakers. There is a constant stream of information for those who are on the journey of self discovery, of self betterment. I find it ironic that despite this, people think it odd and archaic that a priest be involved in the process of confession. The message is clear as is the irony of that message – it’s okay to go to everybody else for advice or help, but a priest? Why would you need to go to a priest?

In honesty, I too pushed back at this idea for a long time – these things are no big deal, I thought, and as long as I’m being honest with God then that’s all that matters. But the accountability is compelling and there is comfort and growth in learning how to confess honestly before someone I trust. I know I am a novice at this practice of confession. I had my first confession just days before baptism and that was a life confession. Think about that for a minute — I’m 54. That’s a lot of life. That’s a whole lot of bad, an abundance of wrong, a life-time of needing to say I’m sorry or I forgive. But in a way that one time life confession feels easier than the regular act of going before God and confessing that I still struggle with the same things – envy, pride, discontent over, and over, and over again. So I still don’t know what to do and when, instead I am learning as I go. But one thing I am clear on is that I need help. one thing I am convinced of is that I need the cross. 

The sanctuary is gradually emptying out. Only a few of us remain. Daylight has gone, replaced by the soft glow of lights and candles in the church. It’s my turn – the wait has ended and I go, nervous but at peace that just as I couldn’t go through my pregnancies without a midwife to walk beside me, I can’t go through my spiritual journey without the same.

To Confess your sins to God is not to tell him anything he doesn’t already know.  Until you confess them, however, they are the abyss between you.  When you confess them, they become the Golden Gate bridge. ~ Frederick Buechner

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Indeed I am Fearfully and Wonderfully Made

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I lay flat on my back, a hospital pillow tucked under my head. The nurse has started an intravenous line in a small vein in my right hand, so skilled that I felt just a needle prick. I have a blood pressure cuff on my left arm, a pulse oximeter on my index finger, and the nodes of an electrocardiogram on my chest. I watch my heart beat through the green of a monitor – the rhythms jagged on the screen. The monitor tells all: my pulse, my blood pressure, my heart beats, the oxygen level in my system. It is the inanimate, all-knowing object in the room. It searches my body and monitors its activity, but it knows nothing of my soul.

I am fearfully and wonderfully made.

Modern medicine can identify many things about the workings of my body and I am grateful. A breast lump caught early gives a woman hope she will enjoy her grandchildren, a polyp identified and taken out means a man can live to see retirement. But only One knows all the goings on in my body.

I am fearfully and wonderfully made.

The nurses and assistants are busy with tasks – I am Preparation Bay 12. “Have you gotten Preparation Bay 12 ready?” says someone who seems to be in charge. I can’t hear the reply but I know the answer because I am Preparation Bay 12. They are kind. They are efficient. But all of us in here are just a part of this day’s work. There is talk of cookies in the break room and laughter from a couple of them recalling something one of their children has done. They will not remember me after I leave today. And that’s okay. Many people enter this place every day. And all day they give of their skills to make sure we who are fearfully and wonderfully made will be well-cared for.

I am fearfully and wonderfully made.

Nothing illustrates this more to me than laying here on this hospital bed. I am more than an electronic green rhythm, I am more than a heart beat, I am more than an oxygen level, I am more than a vein. And while the all-knowing monitor can tell so much, it is the creator who really knows what’s going on. The bones, the vessels, the arteries, the muscles, the tendons, the heart, the brain cells. But most of all the soul.

I lay back and sigh. The nurse comes in and tells me about the medicine that she will be giving me through the intravenous line. It will make me sleepy she says. I probably will sleep through everything and wake up in another room. The last thing I think of before I drift off is that I am fearfully and wonderfully made.

I praise you because I am fearfully and wonderfully made;
your works are wonderful, I know that full well.*
 
From Psalm 139:14
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