What Does It Take?

[Guest poem]

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What does it take
to change a life
from within?

Young and fearless
those 3 words,
inscribed on your chest

Invincible you were
til one day,
gun shots fired

your body running
suddenly ablaze
the sirens wailed

your family prayed
your homies await
your enemies irate

everything hurt
a miracle, you survived
and lived to tell

did you understand
you put your
family at risk?

did it matter
you committed a crime
done did your time

did you realize
a bullet would injure
more than a disk

now, though young
you’re bound to a chair
cannot run, cannot hide

a lifelong disability
you must take in stride
swallow all that gangsta pride

you leave the hospital
vowing to change
yet a few months later

it’s back to the same.

what does it take
to change a life
from within?

[Submission from Soapie, a nurse from the New England area who works in the urban setting. Soapie has been a fellow Christian blogger with David C for years (!), long before this site existed.]

What Does It Take?

Selection Bias: Statistical Integrity in Christian Community

Originally a guest post for the Emerging Scholars Network (a ministry of Intervarsity Christian Fellowship):

One day a num­ber of con­cerned moth­ers met with the min­is­ter to express their frus­tra­tion and anger over the unseemly con­duct of a par­tic­u­lar boy in Sun­day School. They did not want their chil­dren exposed to this child and feared what he rep­re­sented. For it seemed that this boy was mod­el­ing “bad behav­ior” – ver­bal out­bursts that some­times involved pro­fan­ity, a lack of sen­si­tiv­ity to other children’s per­sonal space (occa­sion­ally bit­ing them when irri­tated or pro­voked) and an unpre­dictably vio­lent imag­i­na­tion when play­ing with toys. No Sun­day school is equipped to han­dle prob­lems of this mag­ni­tude. So upon express­ing their indig­na­tion, the moth­ers requested that the min­is­ter call the child’s par­ents and ask that he not return to Sun­day school. Obvi­ously, there were fam­ily issues that needed seri­ous and imme­di­ate attention.

The “prob­lem child” was ours. My wife received the call early one morn­ing. The min­is­ter was deeply apolo­getic and pas­toral in his approach. But the dam­age had been done. What were we to do? Where could we go? Over the years, we had been through behav­ioral pro­grams, fam­ily coun­sel­ing, and psy­chi­atric care. At this point, we were just begin­ning to come to terms with our son’s recent diag­no­sis: Tourette’s syn­drome. Later, he would also be diag­nosed with Asperger’s syn­drome, bipo­lar dis­or­der, and obsessive-compulsive dis­or­der. But at this point he was about seven years old, and we knew only of the Tourette’s. We stopped attend­ing this church. In fact, we stopped attend­ing church alto­gether. — Thomas E. Reynolds, Vul­ner­a­ble Com­mu­nity: A The­ol­ogy of Dis­abil­ity and Hospitality

Engineering does not often apply directly to faith, but one method that has transformed the way I view community is a commitment to statistical honesty. In reading papers and critiques of clinical trials, one thing that comes up repeatedly is the question, “Is the community they engaged in this trial one that is diverse? Does it represent society in general? Can it translate into meaningful implications for the people I treat? Or were these participants selected in a biased way to favor a certain outcome? Is there a skew that limits how we may interpret and understand the world?”

One day it struck me to think about my own community with a similar critique. If I took a random sample of my friends from work, my neighborhood, and my church, would it look like it was truly random? Would there be an overrepresentation of certain types of people or a paucity in others? Would that statistical bias be a reflection of intentionality or a revelation in exclusivity?

I did a brief mental estimation and was not happy with the results. It is my natural human tendency to surround myself with others who think like me, talk like me, and act like me. What I have been grateful for in the work of medicine is being forced into contact with those who are very different from me, those whom, I am ashamed to say, I would not ordinarily choose as neighbors, associates, or friends. Through this means of grace, in the past year alone I have encountered former drug dealers and drug addicts, millionaires and mansion owners, wheelchair riders and deaf academics, judges and janitors, Holocaust survivors and pedophiles, saints and sinners. Though my coworkers (and myself) have often varied in expressions of compassion, we were obligated by both law and ethic to work with them in seeking their greatest benefit.

And so I found myself wondering, “Who is my neighbor? And have I shaped the courses of my encounters, friendships, and associations to suit their needs or my own?” I found that I did not like the answer: that my friends were mainly from certain ethnic groups, certain socioeconomic demographics, certain intellectual capacities and predispositions, certain persuasions of personality and even certain sects of faith. I had groomed and self-selected myself into becoming a statistical outlier in ways incompatible with the gospel, and it grieved me to think of those I had hurt in my exclusivity.

In this season of Lent, it is both sobering and encouraging to consider Christ’s disabled state, the divinity of he whose statistical cross-section of acquaintances included fishermen and Pharisees, tax collectors and political zealots, Samaritans and the blind, lepers and the governor’s wife, Centurions and servants:

Who, being in very nature God,
did not con­sider equal­ity with God some­thing to be grasped,
but made him­self nothing,
tak­ing the very nature of a servant,
being made in human likeness.
And being found in appear­ance as a man,
he hum­bled himself
and became obe­di­ent to death—
even death on a cross!
Philip­pi­ans 2:6–8

Selection Bias: Statistical Integrity in Christian Community

Part 2: On Hope

After a brutal series of Christmas shifts in the ER, I had finally come home for the holidays. My mother and I were in the kitchen, talking like we used to. We had seen and loved the new Les Miserables film, and so I brought up an interesting question from an interview with Samantha Barks, who played Eponine:

Interviewer: I think aside from “I Dreamed a Dream”, “On My Own” is probably one of the most loved songs of the musical, and I think it’s fascinating that the two most recognized and loved are just the two most heartbreaking songs, so what does it say about us as an audience that the songs that we connect with are the most heartbreaking songs?

My mother was quiet as she thought about it. “I think,” she said, “that it is something we all share in common. We all suffer, and know what it means to lose a dream or to be disappointed. We all know how it feels.”

In those moments, I was reminded of how much of her life and our family history was filled with a tragedy not too different from that of Les Miserables. Half of our family tree was missing or unknown, scattered and wiped out during the Communist revolution in China. My grandparents’ histories were characterized by their flight from the war: watching massacres of schoolmates while hiding in the bushes, stepping on dead bodies to avoid landmines, being trafficked via hay carts and ships in order to seek refuge in Taiwan. My parents grew up in the grinding poverty of the rural villages there, their childhood overshadowed by the threat of imminent war, their education grimly driven by the hope of an opportunity to emigrate to the US so that they could form a family here… so that their future children — meaning I — could have a better life.

Without knowing my thoughts, my mother spoke again. “I really like that song from the carriage… where he has the little girl sleeping in his lap and realizes that everything is different now he has a child.” She paused. “You know, everything is different when there is a child. Your whole world changes.” Suddenly, I remembered a day from medical school that struck me the same way:

She wouldn’t stop crying, so I picked her up before realizing that the diaper was wet. The sun was setting and the room was dim and quiet, disturbed only by the peripheral noises of the hospital hallway and the sound of her distress. I gingerly held her up, setting her flat on the bed, and watched her arms wave from side to side as I puzzled over how to change my first diaper.

“Hey,” I whispered. “Stop crying.” She didn’t listen and I spent a few moments fumbling with the pacifier before sitting down in the rocking chair, swinging back and forth easily with the infant cradled in my arms. A plastic music box hanging on the edge of the crib’s stainless-steel safety bars began playing a lullaby. We rocked and swayed, rustling quietly in the dusky shadows of twilight. It was as if the hospital, that crazy world of light and noise and pain and angst, had rumbled off into the distance and lazily forgot to bother us for now.

… I couldn’t recall the details, save the small fact that we were now responsible for her. We, meaning the hospital and the State of New Jersey, who were granted temporary custody as the parents were “currently indisposed of for the time being.” I thought about all the other rooms on the pediatric floor, each of which held two beds: one for the patient and one for the caretaker. Each room had its own guardian: an anxious mother or grandparent or cousin or other relative. Each room except this one.

I remembered the words of a nurse who stood by the bed at rounds, updating us on the baby’s condition. “She’s doing well,” the nurse reported, thoroughly distracted by the baby. The team continued talking about the details of custody and social work while the nurse remained preoccupied. She cooed at the baby. “Hey,” she said quietly, gently caressing the swaddling clothes: “It’s going to be a tough world out there.”

… And so we rocked, back and forth, and I thought and thought. Did she know how alone she was? What kind of person would she become? Who would rise up to defend her weakness, her frailty and vulnerability? If she met me in ten, twenty, thirty years from now, would she still let me hold her in my arms? Why couldn’t I adopt her? How different will it be on the day I hold my own child? Unfamiliar feelings of affection, of unknown protection and helplessness swilled around inside of me, centered but unfocused on this loose bundle of warmed clothing and weak, spastic movements. I didn’t know how to feel or how to respond. I still don’t.

I couldn’t wait to write this stuff down, mainly because I didn’t know what to do with all these ambiguous thoughts. I only held her for a few minutes and yet it’s taken me two days to articulate what I’ve been feeling. Who will love her? Who will dream good dreams for her at night? Who will give her the first cherry ice pop, the first kiss on her scraped knee? Who will keep her safe in this world of terrors?

*****

“I have had this all my life, and I am going to get wid of it!”

“Rid of it,” her therapist corrected.

“W-right.” She turned her head to grin at us, and I couldn’t stop smiling. We were all lying on exercise mats in the therapy rooms because, as the therapist taught us, we could use “gwavity” to help roll those “r’s” better. I was sure she was one of the therapist’s favorite patients: diligent, focused, and with a personality composed entirely of laughter and light. In less than fifteen minutes, through listening to her “chawming pwonun-sheation,” I had already named her as a favorite. Few of my little patients were as mature, knowledgeable, and thrillingly articulate at the dignified age of seven.

And in that moment, I thought about the Newtown massacre and the fact that there must have been precious little difference between any of those children and this young girl who was now sprinkling glitter on a craft snowman, that even the best and brightest of us still live in that same world of terrors.

*****

My mother spoke again. “My favorite song is that one Jean Valjean prays, about bringing him home… it is such a beautiful prayer. He says, ‘You can take, you can give… If I die, let me die; let him live… bring him home.’”

We talked some more, then she said this: “Life is filled with such suffering, you know. There is so much sorrow… but there are moments when God saves.”

That night, I went to my old bedroom and pulled a stack of journals off the bookcase. They were etched on eight, nine, ten years ago with an illegible scrawl that reflected the tired and stress-filled times they were written in. I leafed through the many yellowed pages of thought-scratch, reliving those moments of anxiety and worry. So many of them were desperate calls to God about things I no longer remember now, reflecting crisis after crisis that seem trivial and inconsequential now. I wanted to laugh at the little boy, his deep insecurities and obsession with doubt and suffering, and say, “You haven’t seen anything yet.”

But I didn’t because I realized that even I, the same boy a decade later, am still immersed in my own world of sorrows, conflicts, despair, and cynicism. In the New Year, like every year, we are hopeful that the old wounds of our past will heal, that we can assume a new and a fresh start, that the world will be a better and brighter place… if not for us, then at least for our children, the icons of innocence and hope. But this belies the experiences of our own sordid history as humanity and as individual humans. Is our redemption progressive? Does anything ever change? Are our cries for salvation heard?

Henri Nouwen writes about this in his last book, Can You Drink the Cup?, scripted during his final years as minister at l’Arche Daybreak, a community of those with intellectual disabilities:

There is Tracy, completely paralyzed, but with a bright mind, always struggling to find ways to express her feelings and thoughts. There is Susanne, not only mentally disabled but also regularly battered by inner voices that she cannot control. There is Loretta, whose disability causes her to feel unwanted by family and friends and whose search for affection and affirmation throws her into moments of deep despair and depression. There are David, Francis, Patrick, Janice, Carol, Gordie, George, Patsy… each of them with a cup full of sorrow…

And for me things are not very different. After ten years of living with people with mental disabilities and their assistants, I have become deeply aware of my own sorrow-filled heart. There was a time when I said: “Next year I will finally have it together,” or “When I grow more mature these moments of inner darkness will go,” or “Age will diminish my emotional needs.” But now I know that my sorrows are mine and will not leave me. In fact I know they are very old and very deep sorrows, and that no amount of positive thinking or optimism will make them less. The adolescent struggle to find someone to love me is still there; unfulfilled needs for affirmation as a young adult remain alive in me. The deaths of my mother and many family members and friends during my later years cause me continual grief. Beyond all that, I experience deep sorrow that I have not become who I wanted to be, and that the God to whom I have prayed so much has not given me what I have most desired…

Whose cup is this? It is our cup, the cup of human suffering. For each of us our sorrows are deeply personal. For all of us our sorrows, too, are universal… Jesus, the man of sorrows, and we, the people of sorrow, hang there between heaven and earth, crying out, “God, our God, why have you forsaken us?”…

In his immense loneliness, he fell on his face and cried out: “My Father, if it is possible, let this cup pass me by” (Matthew 26:39). Jesus couldn’t face it. Too much pain to hold, too much suffering to embrace, too much agony to live through. He didn’t feel he could drink that cup filled to the brim with sorrows.

Why then could he still say yes? I can’t fully answer that question, except to say that beyond all the abandonment experienced in body and mind Jesus still had a spiritual bond with the one he called Abba. He possessed a trust beyond betrayal, a surrender beyond despair, a love beyond all fears. This intimacy beyond all human intimacies made it possible for Jesus to allow the request to let the cup pass him by become a prayer directed to the one who had called him “My Beloved.” Notwithstanding his anguish, that bond of love had not been broken. It couldn’t be felt in the body, nor thought through in the mind. But it was there, beyond all feelings and thoughts, and it maintained the communion underneath all disruptions. It was that spiritual sinew, that intimate communion with his Father, that made him hold on to the cup and pray: “My Father, let it be as you, not I, would have it” (Matthew 26:39).

Jesus didn’t throw the cup away in despair. No, he kept it in his hands, willing to drink it to the dregs. This was not a show of willpower, staunch determination, or great heroism. This was a deep spiritual yes to Abba, the lover of his wounded heart…

Our culture tends towards an inflexible sense of optimism and humanism. We are convinced that true joy and human actualization must come through the eradication of pain, suffering, and sorrow. It comes as little surprise then that we hide away the sick and suffering in hospitals and mental institutions and ghettoes, or that conversations about suffering are branded as cynical and faux pas (unless they revolve around the trivial). It is only logical that our perspective on hope is sentimental and, when brutally challenged by events like Newtown or other corruptions of innocence, easily susceptible to cynicism and despair.

In the person of Jesus Christ, whose entrance into the world was humble and threatened by scandal and violence, we are reminded that hope must be divine. It must derive itself from the external, the invisible, and the eternal if it is to pose any help to our intractable, superficial, and fickle humanity. It cannot be the mere absence or abolition of suffering; it must engage it, overcome it, transform it. It does not begin from a position of strength or intimidation; it starts with weakness so that it might express itself in desire and, through satisfaction, bring joy. It has no grounding in idealism, theory, or abstraction; it instead comes from the closeness, the sweetness, and the affection of Jesus Christ, the incarnation of all we hope for and desire.

It is this recognition of Christ’s presence in the hardness of life that brings us liberty and enables us to hope freely and challenge the darkness of cynicism, unburdened by the restrictions of sentimentality and its incongruity with reality. We can live and thrive in the darkest corners of the hospitals, nursing homes, mental institutions, funeral homes, labor camps, and ghettoes simply because Jesus says he lives and thrives there as well.

“Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.

“Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you?  When did we see you sick or in prison and go to visit you?’

“The King will reply, ‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.’” — Jesus (Matthew 25)

For you did not receive a spirit that makes you a slave again to fear, but you received the Spirit of sonship. And by him we cry, “Abba, Father.”  The Spirit himself testifies with our spirit that we are God’s children.  Now if we are children, then we are heirs—heirs of God and co-heirs with Christ, if indeed we share in his sufferings in order that we may also share in his glory. — Romans 8

I want to know Christ and the power of his resurrection and the fellowship of sharing in his sufferings, becoming like him in his death, and so, somehow, to attain to the resurrection from the dead. — Philippians 3

Genocide, massacre, poverty, disappointment, crucifixion, famine, nakedness, death, or sword; together with Christ, with the fellowship of suffering and the drinking of its cup to its dregs, we shall have our overcoming. Somehow, we shall attain.

Happy New Year.

Part 2: On Hope

The Divine Reversal

[Reflection from a morning worship service]

I have been spending time working with children and adults with developmental disabilities this past week. It has been a long week, and to help me process the many emotions and things I saw, I picked up a book to read about theology and disability. The author described the following story in his introduction:

One day a number of concerned mothers met with the minister to express their frustration and anger over the unseemly conduct of a particular boy in Sunday School. They did not want their children exposed to this child and feared what he represented. For it seemed that this boy was modeling “bad behavior” – verbal outbursts that sometimes involved profanity, a lack of sensitivity to other children’s personal space (occasionally biting them when irritated or provoked) and an unpredictably violent imagination when playing with toys. No Sunday school is equipped to handle problems of this magnitude. So upon expressing their indignation, the mothers requested that the minister call the child’s parents and ask that he not return to Sunday school. Obviously, there were family issues that needed serious and immediate attention.

The “problem child” was ours. My wife received the call early one morning. The minister was deeply apologetic and pastoral in his approach. But the damage had been done. What were we to do? Where could we go? Over the years, we had been through behavioral programs, family counseling, and psychiatric care. At this point, we were just beginning to come to terms with our son’s recent diagnosis: Tourette’s syndrome. Later, he would also be diagnosed with Asperger’s syndrome, bipolar disorder, and obsessive-compulsive disorder. But at this point he was about seven years old, and we knew only of the Tourette’s. We stopped attending this church. In fact, we stopped attending church altogether. — Thomas E. Reynolds, Vulnerable Community: A Theology of Disability and Hospitality

In reflecting on these things, the following passage from Scripture came to mind:

You say, ‘I am rich; I have acquired wealth and do not need a thing.’ But you do not realize that you are wretched, pitiful, poor, blind and naked. I counsel you to buy from me gold refined in the fire, so you can become rich; and white clothes to wear, so you can cover your shameful nakedness; and salve to put on your eyes, so you can see.

- Revelation 3:17–18

This is not the time or the place to give a sermon on the nature of disability, but it is a place of worship. Under the Old Covenant, it was sinful man who was charged with the responsibility to humble himself and to sacrifice the blood of animals as a cleansing act of contrition in order to enter into the presence of a Holy and a Mighty God. But now, a New Covenant has been revealed in which the divine order has been reversed. Instead of asking us to repair our disabled selves, Jesus Christ disabled himself to live and breathe and walk among us. Jesus Christ,

Who, being in very nature God,

did not consider equality with God something to be grasped,

but made himself nothing,

taking the very nature of a servant,

being made in human likeness.

And being found in appearance as a man,

he humbled himself

and became obedient to death—

even death on a cross!

-Philippians 2:6–8

This is the God we worship: the Servant King, who became a helpless babe for our sake, who allowed himself to be mocked and beaten and abused for our sake, who became disfigured for our sake, who bore the wrath of God for our sake. It is He, the Compassionate God, who offers us gold to take away our neediness, clothes to restore our dignity, and sight to see as He does.

The Divine Reversal