In reading Ron Chernow’s current biography of George Washington, I was arrested by this quote from a woman who was present in New York at the end of the Revolutionary War and witnessed the British Army, which had occupied the city for most of the war, march out and the Continental Army, which had endured unspeakable hardship in conducting a successful guerilla war against one of the world’s finest armies, march in:

We had been accustomed for a long time to military display in all the finish and finery of garrison life; the [British] troops just leaving us were as if equipped for show, and, with their scarlet uniforms and burnished arms, made a brilliant display. The [Continental] troops that marched in, on the contrary, were ill-clad and weatherbeaten and made a forlorn appearance. But then they were our troops, and as I looked at them and thought upon all they had done and suffered for us, my heart and my eyes were full and I admired and gloried in them the more, because they were weatherbeaten and forlorn. [Ron Chernow, Washington: A Life. New York: Penguin, 2010, p. 450]

The contrast between the resplendent, though defeated, British and the “ill-clad and weatherbeaten,” though victorious, Continentals, brought home to this woman the sacrifices the men she embraced as “our troops” had made to secure her independence.

I, too, am a beneficiary of the sacrifices made by the “ill-clad and weatherbeaten” Continental Army over two centuries. The freedoms I enjoy are a direct result of the suffering they endured. I am grateful to them, and I honor their memory.

By Paul Riddle

I am continually amazed by the resilience of the people I encounter in my work as a hospital chaplain.  Day after day I meet people who show “grace under fire,” meeting the challenges of serious illness, debilitation and loss with courage, dignity, and commitment to their loved ones.

Dawn embodies this spirit.  In their mid-30’s, Dawn and her husband, Blake, have three children and are in the prime of their professional and child-rearing careers.  A few weeks ago, Blake, who had always enjoyed excellent health, was without warning stricken with an illness that required immediate surgical intervention.  The recovery process is arduous, involving many days in ICU and much follow-on treatment.  Dawn has been by Blake’s side throughout this ordeal.  She has enlisted the help of family members to help with the kids, and she has put her own work on hold so she can focus her attention on supporting her husband as he recouperates. 

I have visited Blake regularly throughout his hospital stay.  Due to the nature of his illness and recovery, he spends a lot of time sleeping, so most of my conversations have been with Dawn.  Each time I see her, she gives me a little synopsis of what has happened with Blake since my last visit.  She is up front about the risks and difficulties of Blake’s treatment, but she is also consistently positive in her outlook, claiming each small victory and remaining hopeful for the next.  Together she and Blake have learned to value the little things, the small steps of progress that each day brings. 

I always come away from my visits to Blake and Dawn feeling inspired by their support of one another, and by their resilience.  Never in any of my visits have I heard either of them complain or utter a word of self-pity.  They are both taking this unexpected, unwanted health crisis in stride.  They are living out the words of their marriage vows:  “For better, for worse…”

I give thanks for Blake and Dawn, and for the role models they are for me.  The next time I find myself beset by an unexpected, unwanted crisis, I will remember them. 

I pray God’s blessings on Blake for recovery, and on Dawn as she supports him.

[Note:  Names and certain details have been changed to protect the privacy of the individuals concerned.]

I recently watched with appreciation the PBS Frontline episode, “Facing Death,” aired on November 23, 2010. “Facing Death” takes viewers into the world of several ICU patients, and their families and caregivers as they wrestle with difficult, often heartbreaking end-of-life choices. In each story, the patient was dying, but nobody was willing or able to come out and say so. Doctors, family members, the patients themselves, talked all around the issue but refused to name it, or named it only with great reluctance. In each case, the patient died, and the death was portrayed as a defeat, a failure.
“Facing Death” does an outstanding job of illustrating the issues surrounding end-of-life, yet I was left with a sense that there was a part of the story that was left untold – the story of those who choose to name death and to face it with faith, courage and dignity.
Bonnie Nance was such a person. She served as an elementary school teacher in Texas for over 50 years. I knew her during the years near the end of her life, when she was living in Austin. In her eighties by then, Bonnie was bright, positive, and forward-thinking. She had a wide circle of friends of all ages. She was deeply involved in her church, in several civic activities, and in a professional society for teachers. Single all her life, she had strong relationships with a host of nieces, nephews and other family members. If I live into my eighties, I hope I am the kind of person Bonnie was.
Bonnie enjoyed good health most of her life, but eventually time caught up with her and her body began to wear out. Her kidneys began to fail. When her doctors told her her kidneys were failing and that she would have to go on dialysis, she replied, “No, I don’t.” “Excuse us,” her doctors said. “No, I don’t have to go on dialysis,” Bonnie replied, “and I don’t intend to.” “But without dialysis, you’ll die!”her doctors said. “I never expected to live forever,” Bonnie responded, “I’m 85 years old, I’ve led a full life, I’m content, I’m at peace with everyone I care about, and I’m confident that the God who is with me in this life will be with me in the next. It is my time.”
And so it was. Bonnie declined dialysis, went into hospice care, and died peacefully about ten days later. Her final days were filled with visits from friends and family members, laughter, tears, and goodbyes – just as she wanted. Bonnie Nance died on her own terms.

[NOTES: 1) “Facing Death,” along with a wealth of related material, can be viewed at http://www.pbs.org/wgbh/pages/frontline/facing-death. 2) The conversation between Bonnie and her doctors is the product of my imagination; however, based on my own conversations with Bonnie about that meeting, it captures the spirit of what actually took place. PR]

Lizzie’s energy lit up the room. When I walked in, she greeted me with an enthusiastic, “Hello, Paul!” She was sitting up in bed, bouncing with excitement. Jen, her art teacher, had just arrived and they were about to begin a watercoloring session. Lizzie’s face was bright, and her zest for life was infectious. Everyone in the room was warmed by her glow.

So different from the sad, frightened child I had seen a couple of months ago when I first met her. Injured in a serious car accident that had claimed part of one of her limbs, Lizzie was traumatized not only in body but in spirit as well. What a shock for a child of seven to go through! What a shock for anyone to go through. At our first meeting Lizzie was huddled under the sheets, tentative, almost afraid to engage anyone new, like an injured animal licking its wounds.

Slowly at first, she began bit by bit to adjust. Her mother, Sarah, was by her side constantly, encouraging, supportive, present. And the medical staff couldn’t have been better. Not only the doctors and nurses addressing her physical injuries, but also the child life specialists, physical therapists, chaplains and others who provided emotional and spiritual support. Also family friends, relatives, and her church community all stepped up.

Today was to be our last visit, and we both knew it. Lizzie was to be transferred later that day to a different hospital, where she could receive additional, specialized care. It was a joyful visit, and when it was over she gave me a hug.

Walking away from the room, I felt a sense of joy at the progress Lizzie had made, along with a twinge of sadness that my role in her care had come to an end. I also marveled at God’s ability to mend that which is broken – to bring healing and wholeness to injured bodies and spirits.

I treasure my brief association with Lizzie. In our visits, I sought to provide spiritual support, but I also received a blessing from God through her. For that I am thankful.

Blessings to you, Lizzie. May God strengthen, sustain and guide you all your days.

I want to commend a book to you that came to my attention at a Palliative Care Grand Rounds session at Methodist Hospital a few weeks ago. The book is entitled, Mastering Communication with Seriously Ill Patients: Balancing Honesty With Empathy and Hope, by Anthony Back, Robert Arnold, and James Tulsky (New York: Cambridge University Press, 2009 ISBN 978-0-521-70618-6).

This book is written by physicians for physicians, and it addresses a pressing need in healthcare: The need for better communication between doctors and patients. The authors acknowledge that, for many physicians, communication is not their strong suit. They then proceed to lay out a practical, positive approach that doctors can use to relate more effectively with their patients. What impressed me, aside from the very fact that the book exists, is how similar the emphasis of Back, Arnold and Tulsky is to the emphasis of our training of volunteers and interns at Lifeline.

The authors articulate seven principles which illustrate their overall approach (pp. 6-7):

1. Start with the patient’s agenda.
2. Track both the emotion and the cognitive data you get from the patient.
3. Stay with the patient and move the conversation forward one step at a time.
4. Articulate empathy explicitly.
5. Talk about what you can do before you talk about what you can’t do.

Chapters are devoted to such thorny doctor-patient communication issues as: Talking about serious news; discussing prognosis; conducting a family conference; dealing with conflict; transitions to end-of-life care; talking about dying; and saying goodbye. In each chapter the authors lay out the problem, illustrate it, and lay out a “road map” for the physician to build communication skill in that area. Especially helpful are verbatim-like text boxes in which samples of a conversation are laid out under two columns: “What Happened” and “What We Can Learn.”

The authors function as empathetic, though uncompromising, coaches, providing their fellow physicians with practical tools, challenges, and encouragement in improving their relational skills.

Even though the book is written for physicians, I found it to be a very helpful review of basic communication skills and strategies. It merits close attention by anyone who works closely with persons dealing with serious illness and loss.

As we enter a new year, I’m involved in several projects that have to do with making a new start. First, I’m involved in my church’s search for a new preaching minister – always a time of renewal for a church. Second, I’m writing letters of recommendations for three former Lifeline interns who are applying to graduate programs – one in medicine and two in ministry. Third, I’m serving on a Board Certification committee for a new chaplain.

I’m excited to be a part of helping to launch these new beginnings in the lives of people I care about. Not only do I find this work personally satisfying, I also find it spiritually uplifting. At the core of my personal theology is the conviction that God’s main line of business – at least as far as human beings are concerned – is redemption, the making of new beginnings. When I serve on a selection committee, when I help a new chaplain or a former intern launch a career or begin a course of formation, I feel that I’m participating in a small way in God’s Kingdom work of making all things new, and that leaves me with a feeling of deep satisfaction.

God’s blessings to you this week.

Emma’s deep, racking cough shook the room. It had persisted over many days, despite the best efforts of her doctors, nurses, respiratory therapists, and other caregivers. Although she had great difficulty talking in between coughing fits, she insisted that I stay. Her family, who were usually present, were not in the room, and she wanted to talk.

“This is not going to go on much longer,” she declared. “Not going to go on much longer?” I asked. “I’m dying,” she said matter-of-factly. Thus began a deep conversation in which she did most of the talking and I did most of the listening.

Emma was very much at peace with her life, at peace with herself, and at peace with God. Looking back over her life, she was able to see many times in which God had been there for her, providing protection, opening doors of opportunity, providing needed resources just when they were needed.

Church had always been a source of replenishment for Emma. Reflecting on the years when she was raising her children, juggling the demands of being a single parent and holding down a full-time job, she said it was always important for her to go to services at church anytime the doors were open – Sunday morning, Sunday evening, Wednesday night – even when she was bone weary. “What was it about church that caused you to go even when you didn’t want to?” I asked. “My flowers needed watering,” she said simply.

“My flowers needed watering.” That phrase was Emma’s metaphor for what church meant to her. It was where she went for replenishment. It was where her friends were. It was where she encountered God in special ways. It was home.

I must confess that Emma watered my flowers that day. I was moved by her forthrightness in facing her approaching death, and I was uplifted by her simple trust in the God who had been faithful to her in so many ways over the course of her life. I told Emma how much her faith encouraged me, and her face, worn with illness, brightened. By God’s grace, we both received a blessing that day.

All praise to the God and Father of our Master, Jesus the Messiah! Father of all mercy! God of all healing counsel! He comes alongside us when we go through hard times, and before you know it, he brings us alongside someone else who is going through hard times so that we can be there for that person just as God was there for us.

2 Corinthians 1:3 (The Message)

Earlier in my career, I served almost a decade as a chaplain in the United States Navy. During those years, I spent a lot of time aboard warships at sea, supporting the sailors and Marines who form the backbone of our sea services.

One of the indelible images that remains with me from my years at sea is that of an operation known as underway replenishment (or, in Navy jargon, UNREP). When a Navy ship needs more fuel, food or other supplies, it doesn’t always have the luxury of pulling into the nearest port like you or I would pull our cars into the nearest gas station or convenience store. It has to be able to get what it needs through underway replenishment. During an UNREP, the ship comes alongside a support ship, hoses and lines are strung between the two ships (which, by the way are moving), and the support ship provides whatever is needed. It’s thrilling, and a little scary, being aboard a ship during an UNREP. The ships are close together, and the operation tests the nerve and shiphandling skills of both crews, but the result is worth the effort.

“Coming alongside” is an apt image for the spiritual care Lifeline’s volunteers provide to the patients and families we serve. In underway replenishment, each ship is fully seaworthy and has its own captain and crew. The supply ship doesn’t take over the mission of the other ship. It simply comes alongside and provides the support that is needed. Similarly, in pastoral encounters with patients and family members, our volunteers come alongside, not to fix or to take over, but to listen, to pray, and to engage in caring conversation. By doing these things – and even more importantly by simply being there – our volunteers offer reassurance of God’s steadfast love and abiding presence. This is the unique contribution spiritual care makes to patients’ healing and wholeness.

This contribution is reflected in the following lines from a patient, recently discharged from Methodist Hospital, who wrote to express her thanks to Lifeline’s volunteers who came alongside her and her family during a long illness:

Thank you all for such a wonderful ministry. I appreciate all the visits, prayers, communion, and support for my family during my lengthy 2-month stay at Methodist Hospital in Houston. It was so nice being so far away from our own congregation, but having brothers and sisters in Christ to visit. Special thanks to [several named volunteers] and all the others that continued to pray for us. In Christian love…

Throughout Calendar Year 2009, the people of my church have participated in a spiritual discipline called Dwelling in the Word. We agreed to read a particular text daily (or almost daily) and reflect on it. The text we’ve been dwelling in is 2 Corinthians 4:1-12, known to many as the passage that contains the famous phrase, “We have this treasure in earthen vessels…”

I have found Dwelling in this passage to be a beneficial experience. Phrases from the text flit through my consciousness as I go about my business. The text has become a lens through which I view the world.

As the year draws to a close, here are some resolutions for 2010 based on my Dwelling in 2 Corinthians 4 this year:

Resolved:

To remain hopeful when things get tough;

To be open, aboveboard, honorable and accountable in my dealings with people;

To live in the light and avoid the darkness.

To honor the “earthen vessels” into which God has chosen to deposit the treasure of the Kingdom.

To acknowledge God’s power and sovereignty in accomplishing his redemptive purposes in this world;

To bend but not break when adversity strikes;

To be realistic about death, but also to be realistic about the limits of its power;

To live in the assurance that God’s core business, as regards human beings, is redemption, new life, and new beginnings.

As I write this, I’m sitting in the living room of a home built by the Honorable Bartholomew Manlove. Colonel Manlove, a native of Kentucky, was the first mayor of Bastrop, Texas. This house was constructed in 1835, one year before Texas Independence. The mayor once conducted official business from the room in which I’m sitting. The house has been continuously occupied ever since it was built and is now a bed and breakfast inn.

What strikes me is the sheer amount of living that has taken place in this house. Generations of children have been born and have grown up here, countless weddings have been celebrated here, many wakes and funerals, and thousands of days of ordinary living.

Those who built this house, and most of those who have lived in it, are now long gone. But their mark remains. Floor boards sawn, finished and placed by hand. Panes of glass from the first windows installed (the original house had shutters – which remain – but no glass windows. Remnants of the first indoor plumbing and electric wiring (now modernized). Voices, ghosts and spirits of 175 years’ worth of owners, families, guests, and servants.

These generations of people have come and gone. Each has left his or her mark, on this house. And this house has left its mark on each of them.

It occurs to me that this old house is a bit like life. Each of us passes through it. We leave our mark on it, and it leaves its mark on us.

I can’t slow down, speed up or stop the passage of time. But I can choose what I will do today. How I will respond to the situations that arise. How I will treat the people I encounter. In that way I choose the mark I leave on this old house called life.