Perhaps I'm mistaken, but I thought the Pope was the leader of the Roman Catholic Church! What was he doing becoming involved in an Australian parish that welcomed ordinands from a local Episcopal Church? Their Church had burned and they had no place for their ordinations. The Roman Catholic priest welcomed them and the Pope forbade the ordinations in that Roman Catholic Church because several of the ordinands were women and the Roman Catholic Church does not allow women to be ordained.
What does one have to do with the other here? It is not the place of the Pope or any other Church leader to making sinful rulings. No one expected the Pope to recognize the newly ordained priests. Certainly, they were not looking for support from the Roman Catholic Church; only simple hospitality at a time of unfortunate circumstances.
Yes, these questions do fit into a blog on spirituality and the poor. Consider the ordinands as well as the Roman Catholic pastor who were involved in this craziness. The Roman Catholic Church speaks of ecumenism, but obviously does not want to become too deeply involved in outreach and pastoral care.
The poor in this story are those who have been called to priestly ministry in the Episcopal Church and who have no place for the ordinations to take place. Additionally, the considerate and pastoral parish priest is poor in that, despite his best intentions, the Pope rescinded the invitation to use the parish church based upon his marginalization of women and refusal to consider the roles that women assumed in the early church (Yes, before there was a Pope).
If we are going to be Christ-like women and men, we must move beyond outrage at what hymns are sung on Sunday, where the altar candles should be placed, women in the Church speaking to important issues and concerns, and many other areas of minutia. How? I certainly don't have all of the answers, but I am formulating letters to the US Conference of Catholic Bishops, to the Vatican (hopefully to Benedict), Local bishops, clergy, and others in both Roman Catholic and Episcopal parishes as well as our own Presiding Bishop.
I believe that if Jesus ever meant to marginalize anyone, the first would have been Peter and his inability to "get it." Obviously, that was not the case. Jesus taught us to respect all persons and to accept and love one another as equal. Perhaps Benedict simply has not read the gospels with an open mind and heart.
If you are so moved, I urge you to write to your bishops and priests; to write to diocesan newspapers and local news sources and have them make this sinful marginalization by the Pope known to all. Trust me, the idea of doing this is daunting. The need to do so is immediate.
Tuesday, December 29, 2009
Monday, December 28, 2009
The Church Often Creates Poverty
My friends continue to ask me why I regularly read THE MIRROR (the bi-monthly newspaper of the Roman Catholic Diocese of Springfield-Cape Girardeau, Missiouri). My roommate and I have spent considerable time in and near Cape Girardeau during her parent's illness and death and now, the holidays. It seems reasonable to know what is going on around us in the church.
Unfortunately, THE MIRROR has a negative impact on me; my blood pressure becomes dangerously high and I want to call the columnists and ask in which world and century they live! Most months, I feel as if I have been sent back to the time of Pope Pius XII or earlier. The columnists leave no "wiggle" room nor do they encourage one brain cell to engage. On more occasion, I expect some picture of God to accompany the columns since some of the columnists write as if they were God.
How does the Church create poverty? One means is by the publication of diocesan papers such as THE MIRROR and the ultra-conservative columnists who write regularly for this paper. Imagine having recently agonized over removing a parent from life support (honoring that parent's advance directive) and then reading a MIRROR column that states that this is legalized murder! How might life on a respirator with gradual decreasing muscle tone, choaking on one's own saliva, the inability to keep one's head upright, all while fully aware of what is happening and that these symptoms will only worsen be accepted by the columnist who spoke as if he were infallabile (or perhaps, even God). Those children who loved their parents so very much, respected their wishes to not be kept alive artificially and they fought a system of physicians who could not seem to agree with one another about life support, a church that tells them that, in essence, they are murderers are faithful Roman Catholics. Only by the grace of God, were they able to believe that following their parent's wishes was the only way for them.
On the other hand, I can easily imagine someone whose parents had never written advance directives. Now, the adult child is present when the parent has difficulty breathing and says "yes" to a respirator. One week stretches into four and four weeks merge into six months, and there is no change in the parent's condition. The Church would say to the adult child, "Well done good and faithful servant...." while the decision maker wonders just he/she had done.
Churches can make any claims that they want to, but ultimately, God is the only one to Whom we must answer. I believe that the mind of God is much more open that the mind of the Church. We were created with minds of our own and our life focus is to live as God has taught us in Sacred Scripture and through generations of other followers of God and the Christ.
Creating doubt and worse, pointing an accusatory finger in situations such as I have described, is not acceptable. We, as followers of Jesus Christ, have absolutely no authority to dehumanize and marginalize others in matters such as these. I believe that when these family members meet God, they will hear, "Well done good and faithful servants, enter the dominion which has been prepared for you since the beginning of time."
Unfortunately, THE MIRROR has a negative impact on me; my blood pressure becomes dangerously high and I want to call the columnists and ask in which world and century they live! Most months, I feel as if I have been sent back to the time of Pope Pius XII or earlier. The columnists leave no "wiggle" room nor do they encourage one brain cell to engage. On more occasion, I expect some picture of God to accompany the columns since some of the columnists write as if they were God.
How does the Church create poverty? One means is by the publication of diocesan papers such as THE MIRROR and the ultra-conservative columnists who write regularly for this paper. Imagine having recently agonized over removing a parent from life support (honoring that parent's advance directive) and then reading a MIRROR column that states that this is legalized murder! How might life on a respirator with gradual decreasing muscle tone, choaking on one's own saliva, the inability to keep one's head upright, all while fully aware of what is happening and that these symptoms will only worsen be accepted by the columnist who spoke as if he were infallabile (or perhaps, even God). Those children who loved their parents so very much, respected their wishes to not be kept alive artificially and they fought a system of physicians who could not seem to agree with one another about life support, a church that tells them that, in essence, they are murderers are faithful Roman Catholics. Only by the grace of God, were they able to believe that following their parent's wishes was the only way for them.
On the other hand, I can easily imagine someone whose parents had never written advance directives. Now, the adult child is present when the parent has difficulty breathing and says "yes" to a respirator. One week stretches into four and four weeks merge into six months, and there is no change in the parent's condition. The Church would say to the adult child, "Well done good and faithful servant...." while the decision maker wonders just he/she had done.
Churches can make any claims that they want to, but ultimately, God is the only one to Whom we must answer. I believe that the mind of God is much more open that the mind of the Church. We were created with minds of our own and our life focus is to live as God has taught us in Sacred Scripture and through generations of other followers of God and the Christ.
Creating doubt and worse, pointing an accusatory finger in situations such as I have described, is not acceptable. We, as followers of Jesus Christ, have absolutely no authority to dehumanize and marginalize others in matters such as these. I believe that when these family members meet God, they will hear, "Well done good and faithful servants, enter the dominion which has been prepared for you since the beginning of time."
Tuesday, November 17, 2009
Decision Making When a Child is Critically Ill
A recent news story reminded me of the difficult decisions faced by many parents when one of their children is seriously ill. This was the story of an infant who was born with a rare condition which would necessitate his constant use of a respirator and increased difficulty moving or doing anything for himself if he lived through the early days in the hospital.
The problem was compounded by parental disagreement regarding the continuation of the endotracheal tube. Further complicating this delicate decision was that the parents were divorced. As the situation stood last week, the father would not give permission to remove the endotracheal tube and the infant remained on a respirator.
In recent and previous postings, we have mourned the deaths of two elderly people whose loving children made difficult decisions in standing with the wishes that were documented in both Advance Care Directives. Certainly, one cannot quantify difficulty when examining these situations. It is however, understandable that might believe in a more conservative approach in the case of an infant; or would we?
Is it responsible to keep an infant sedated and on a respirator and call that life? How long does the medical/legal system allow conflicting parental beliefs to halt decision making? Although the parents are the legal guardians and decision makers for the infant, does this authority have no time limit when there are moral and ethical questions?
Several days ago, this infant's father agreed to the removal of the endotracheal tube and respirator. The physicians suggested highly sedating the infant in order to reduce any discomfort or pain as his respirations became more labored and he finally died. As planned, this little one was removed from life support, and died peacefully.
Each time I read an update on this case, it appeared to me that the father was being demonized by his reluctance and refusal to let his infant child die peacefully. What was unsaid and either forgotten by readers and others is that we all come to decisions differently. I can't imagine being faced with such a decision. Despite deep faith, education, and normally rational thinking, our emotions often lead in decision making. Often, we can't come to terms with our own emotions.
Who were the poor here? All three individuals were. The infant had survived pregnancy only to be without the ability to sustain life. His poverty was in not being able to experience the richness of life and the sustained love of his parents and others. Certainly the parents experience poverty through the stress of conflicting beliefs regarding discontinuing life support. I must admit that I initially thought the father to be ill informed and selfish until I asked myself what I would do in a similar situation. Emotionally, this would be awful for me (for most of us).
Despite that poverty, the parents were able to sort through the reality of an infant who would never be without a respirator and who would be prone to infections, and would loose the use of his arms and legs due to nerve damage. When the question was "not about me" but about the well being of their infant, they came together, and despite the pain and sorrow, they allowed their infant to return to the arms of a loving God.
We narrow our understanding of poverty to lack of material THINGS and refuse to realize the poverty that those around us experience with few, if any, visible signs, then we are missing much needed ministry of care and support. I pray that this is an eye opener and that we will "tune in" to those around us and become intuitive and insightful when meeting our neighbors.
The problem was compounded by parental disagreement regarding the continuation of the endotracheal tube. Further complicating this delicate decision was that the parents were divorced. As the situation stood last week, the father would not give permission to remove the endotracheal tube and the infant remained on a respirator.
In recent and previous postings, we have mourned the deaths of two elderly people whose loving children made difficult decisions in standing with the wishes that were documented in both Advance Care Directives. Certainly, one cannot quantify difficulty when examining these situations. It is however, understandable that might believe in a more conservative approach in the case of an infant; or would we?
Is it responsible to keep an infant sedated and on a respirator and call that life? How long does the medical/legal system allow conflicting parental beliefs to halt decision making? Although the parents are the legal guardians and decision makers for the infant, does this authority have no time limit when there are moral and ethical questions?
Several days ago, this infant's father agreed to the removal of the endotracheal tube and respirator. The physicians suggested highly sedating the infant in order to reduce any discomfort or pain as his respirations became more labored and he finally died. As planned, this little one was removed from life support, and died peacefully.
Each time I read an update on this case, it appeared to me that the father was being demonized by his reluctance and refusal to let his infant child die peacefully. What was unsaid and either forgotten by readers and others is that we all come to decisions differently. I can't imagine being faced with such a decision. Despite deep faith, education, and normally rational thinking, our emotions often lead in decision making. Often, we can't come to terms with our own emotions.
Who were the poor here? All three individuals were. The infant had survived pregnancy only to be without the ability to sustain life. His poverty was in not being able to experience the richness of life and the sustained love of his parents and others. Certainly the parents experience poverty through the stress of conflicting beliefs regarding discontinuing life support. I must admit that I initially thought the father to be ill informed and selfish until I asked myself what I would do in a similar situation. Emotionally, this would be awful for me (for most of us).
Despite that poverty, the parents were able to sort through the reality of an infant who would never be without a respirator and who would be prone to infections, and would loose the use of his arms and legs due to nerve damage. When the question was "not about me" but about the well being of their infant, they came together, and despite the pain and sorrow, they allowed their infant to return to the arms of a loving God.
We narrow our understanding of poverty to lack of material THINGS and refuse to realize the poverty that those around us experience with few, if any, visible signs, then we are missing much needed ministry of care and support. I pray that this is an eye opener and that we will "tune in" to those around us and become intuitive and insightful when meeting our neighbors.
Tuesday, November 10, 2009
Alzheimer's Disease and Family Care Givers
AOL's news of the day just posted the story of an 84 yr. old gentleman living with Alzheimer's Disease and his 53 yr. old caregiver son. Only by the grace of God are the events revealed in this story, not enacted time and time again in similar situations.
Son and father had apparently never had a close relationship. Once the father was diagnosed with Alzheimer's Disease and began to have serious enough symptoms that he could not be left alone, his son became his caregiver. The story reveals a difficult to care for man and a son who is frustrated and angered by his father's outbursts and failure to listen to him.
One late afternoon, a friend called the son and invited him to join her at the beach. Of course, he would have to take his father along. Not long after arriving at the beach, the father wandered down toward the water and took both his outer shorts and diaper off. The son immediately went to his father and roughly threw the diaper into the water and tried to retrieve the outer shorts which his father insisted "I don't want on."
From this point, the events are muddled. Some witnesses reported that the son dragged his father to the water and that, although he was not totally under water, he was ingesting water and becoming non responsive. Others said that it took the son a considerable amount of time to attempt to respond to his father's distress. When several persons phoned for an ambulance, the son was reported to be angry and yelling that there was no need for the ambulance. When it arrived, the son told the paramedics to leave; that they were not needed.
Despite the son's protests, the gentleman was taken to the emergency room. He was eventually moved to the intensive care unit where he died the next morning. Autopsy revealed conditions compatible with near drowning and the death was declared to be a homicide.
The situation and actions described in the article are deplorable. Those of us who have never been primary caregivers to parents with dementia/Alzheimer's Disease or other memory/abusive conditions, have no idea what that must be like. Neither we, nor our parents expect that we will be changing their incontinent pads or orientating them to time and place repeatedly, or finding ourselves the target of abusive language and lack of cooperation.
This is truly an opportunity to reach out to the caregiver as Jesus has told us that we must do in order to truly be his disciples. It is easier for most of us to respond to something tangible such as lack of food, the loss of a home or job or insurance. How do we respond when someone has a disease such as Alzheimer's that gradually muddles their memory, recognition, self sufficiency.
They have been stripped of much of what makes us human.
There simply is no excuse for the actions of the son in the AOL story yet, in many instances, "there but by the grace of God are we." I've seen it in nursing homes where staff hear the same things, observe the same behaviors, and feel the same frustration eight hours a day, 40 hours a week, and they finally find themselves grabbing a resident's arm and nearly dragging them to the dining room because telling them it is time for lunch and taking their hand yields no response other than opposition. Adult children stop visiting their parents because they have had the same conversation each visit for over a year.
Here, you and I must ask in all sincerity, "what would Jesus do?" We know the answer. He would reach out to those caregivers and offer them respite. He would listen to their concerns and the venting of their anger and frustration, and he would encourage them to return to their loved one remembering that despite forgetfulness, anger, rejection, confusion, they are still one's parent's and that we, as Christians, are called to love them as we did when we could laugh and tell stories, make shared decisions, and not worry about them disrobing, swearing at absolutely nothing, and pushing us away. Jesus does not promise that all of life will be easy, but he does give us guidelines to help us through both the good and the rough times.
Son and father had apparently never had a close relationship. Once the father was diagnosed with Alzheimer's Disease and began to have serious enough symptoms that he could not be left alone, his son became his caregiver. The story reveals a difficult to care for man and a son who is frustrated and angered by his father's outbursts and failure to listen to him.
One late afternoon, a friend called the son and invited him to join her at the beach. Of course, he would have to take his father along. Not long after arriving at the beach, the father wandered down toward the water and took both his outer shorts and diaper off. The son immediately went to his father and roughly threw the diaper into the water and tried to retrieve the outer shorts which his father insisted "I don't want on."
From this point, the events are muddled. Some witnesses reported that the son dragged his father to the water and that, although he was not totally under water, he was ingesting water and becoming non responsive. Others said that it took the son a considerable amount of time to attempt to respond to his father's distress. When several persons phoned for an ambulance, the son was reported to be angry and yelling that there was no need for the ambulance. When it arrived, the son told the paramedics to leave; that they were not needed.
Despite the son's protests, the gentleman was taken to the emergency room. He was eventually moved to the intensive care unit where he died the next morning. Autopsy revealed conditions compatible with near drowning and the death was declared to be a homicide.
The situation and actions described in the article are deplorable. Those of us who have never been primary caregivers to parents with dementia/Alzheimer's Disease or other memory/abusive conditions, have no idea what that must be like. Neither we, nor our parents expect that we will be changing their incontinent pads or orientating them to time and place repeatedly, or finding ourselves the target of abusive language and lack of cooperation.
This is truly an opportunity to reach out to the caregiver as Jesus has told us that we must do in order to truly be his disciples. It is easier for most of us to respond to something tangible such as lack of food, the loss of a home or job or insurance. How do we respond when someone has a disease such as Alzheimer's that gradually muddles their memory, recognition, self sufficiency.
They have been stripped of much of what makes us human.
There simply is no excuse for the actions of the son in the AOL story yet, in many instances, "there but by the grace of God are we." I've seen it in nursing homes where staff hear the same things, observe the same behaviors, and feel the same frustration eight hours a day, 40 hours a week, and they finally find themselves grabbing a resident's arm and nearly dragging them to the dining room because telling them it is time for lunch and taking their hand yields no response other than opposition. Adult children stop visiting their parents because they have had the same conversation each visit for over a year.
Here, you and I must ask in all sincerity, "what would Jesus do?" We know the answer. He would reach out to those caregivers and offer them respite. He would listen to their concerns and the venting of their anger and frustration, and he would encourage them to return to their loved one remembering that despite forgetfulness, anger, rejection, confusion, they are still one's parent's and that we, as Christians, are called to love them as we did when we could laugh and tell stories, make shared decisions, and not worry about them disrobing, swearing at absolutely nothing, and pushing us away. Jesus does not promise that all of life will be easy, but he does give us guidelines to help us through both the good and the rough times.
Friday, October 30, 2009
The Working Poor
I'll admit that I often do not especially think of the working poor. I walk among and with them daily, yet do not let the poverty into my consciousness. This reality came to me yesterday as I unwrapped the book I need to read in preparation for a conference call and discussion.
This past summer, I spent four days with several hundred Sisters and Associates of a Franciscan community. One of our tasks was to gather with the work/ministry groups that we had chosen several months earlier. I had chosen the "poverty" group. Discussion nearly immediately focused on the working poor. On several occasions, I interjected the need to look beyond monetary and physical poverty. My several suggestions were the poor who are in mourning, feeling disenfranchised, are seriously ill, have no family members and/or are all alone during difficult times. My comments were acknowledged, yet there was no further comment along the lines I had suggested. As our meeting drew to a close, we were reminded to read THE WORKING POOR by November!
Last Sunday, I was honored to celebrate the Eucharist in the parish where I am a priest in residence. The folks who attended the 8 AM Mass voiced their concerns regarding the calling of a new priest. The rector of nine years resigned this past July and the parish administration is in the hands of the vestry and a rota of "supply" priests. The 10 AM folks appeared to be a bit less disturbed by the process of calling an interim priest yet, the atmosphere during the service and coffee hour was subdued.
I see parishioners in similar situations as members of the "poor." This is a poverty of spirit as they worship with a different priest every week. Although the parishes had suffered financially, things had been picking up. Now, all there seems to be is uncertainty. This is hardly an isolated situation. Roman Catholic parishes are struggling with bishops who appoint "Old Rite" priests who want to return the Mass to Latin, turn the altar toward the wall, and sing hymns that have no basis in the changes of Vatican Council II. There is a parish in our community where these reversals of Vatican II have taken place and over 200 parishioners have split from that parish and now worship without a priest.
GLBT women and men continue to find failure to legalize their relationships as marriages. They are denied the richness of open, honest, loving relationships and the support that brings couples. Additionally, they are denied health care insurance, the ability to adopt children, and the involvement of the the other in work community sharing, parties, discussion groups and the like. Gay Roman Catholic priests are not able to be open about their sexual orientation. Despite the recent invitation of the pope to Anglican clergy who are in disagreement with gay/lesbian clergy and women bishops, those gay Anglican dissidents will need to remain hidden lest they find they do not fit into the Roman Catholic Church.
Lesbian Roman Catholic Sisters most certainly are present in many religious communities. The second of a three stage "inquisition" of American Religious Orders of women, questions the membership of lesbians in communities, as well as how often the sisters confess their sins, attend Mass, and other "concerns."
Lastly, I think of my own mother who is nearly 84 years old. She has been a widow for 21 years and she lives in an apartment complex of mostly older single and married women and men. Initially, my sister lived nearby, but she and her husband moved to London and Mom only saw them a couple of times a year. Their six children all saw Grandma's as a hub for connection as they made their ways back and forth from London to Chicago. Now, the only family left in Chicago is one 30+ yr. old grandson and his spouse. They get together for supper occasionally, and Mom is thrilled to still have someone nearby.
Jesus and Francis loved the poor and reached out to them no matter what the source of their poverty. My greatest concern is that we not narrow our view and therefore, exclude all who need our love, support, care and prayers.
This past summer, I spent four days with several hundred Sisters and Associates of a Franciscan community. One of our tasks was to gather with the work/ministry groups that we had chosen several months earlier. I had chosen the "poverty" group. Discussion nearly immediately focused on the working poor. On several occasions, I interjected the need to look beyond monetary and physical poverty. My several suggestions were the poor who are in mourning, feeling disenfranchised, are seriously ill, have no family members and/or are all alone during difficult times. My comments were acknowledged, yet there was no further comment along the lines I had suggested. As our meeting drew to a close, we were reminded to read THE WORKING POOR by November!
Last Sunday, I was honored to celebrate the Eucharist in the parish where I am a priest in residence. The folks who attended the 8 AM Mass voiced their concerns regarding the calling of a new priest. The rector of nine years resigned this past July and the parish administration is in the hands of the vestry and a rota of "supply" priests. The 10 AM folks appeared to be a bit less disturbed by the process of calling an interim priest yet, the atmosphere during the service and coffee hour was subdued.
I see parishioners in similar situations as members of the "poor." This is a poverty of spirit as they worship with a different priest every week. Although the parishes had suffered financially, things had been picking up. Now, all there seems to be is uncertainty. This is hardly an isolated situation. Roman Catholic parishes are struggling with bishops who appoint "Old Rite" priests who want to return the Mass to Latin, turn the altar toward the wall, and sing hymns that have no basis in the changes of Vatican Council II. There is a parish in our community where these reversals of Vatican II have taken place and over 200 parishioners have split from that parish and now worship without a priest.
GLBT women and men continue to find failure to legalize their relationships as marriages. They are denied the richness of open, honest, loving relationships and the support that brings couples. Additionally, they are denied health care insurance, the ability to adopt children, and the involvement of the the other in work community sharing, parties, discussion groups and the like. Gay Roman Catholic priests are not able to be open about their sexual orientation. Despite the recent invitation of the pope to Anglican clergy who are in disagreement with gay/lesbian clergy and women bishops, those gay Anglican dissidents will need to remain hidden lest they find they do not fit into the Roman Catholic Church.
Lesbian Roman Catholic Sisters most certainly are present in many religious communities. The second of a three stage "inquisition" of American Religious Orders of women, questions the membership of lesbians in communities, as well as how often the sisters confess their sins, attend Mass, and other "concerns."
Lastly, I think of my own mother who is nearly 84 years old. She has been a widow for 21 years and she lives in an apartment complex of mostly older single and married women and men. Initially, my sister lived nearby, but she and her husband moved to London and Mom only saw them a couple of times a year. Their six children all saw Grandma's as a hub for connection as they made their ways back and forth from London to Chicago. Now, the only family left in Chicago is one 30+ yr. old grandson and his spouse. They get together for supper occasionally, and Mom is thrilled to still have someone nearby.
Jesus and Francis loved the poor and reached out to them no matter what the source of their poverty. My greatest concern is that we not narrow our view and therefore, exclude all who need our love, support, care and prayers.
Tuesday, October 6, 2009
Strength in the midst of Pain and Loss
This is a continuation of my last entry. My roommate received a phone call from her sister in Missouri. Their mother (wife of "John" from the post) had become weak and disoriented in the nursing home and had been taken to the Emergency Room and admitted to the Critical Care Unit where she was being monitored. It didn't seem necessary for "Liz" to come home yet. The following morning we were awakened by the same sibling saying that their mother was not improving and less than 30 minutes later, we were called again telling us to come to Missouri; all the (adult) children would be gathered at the hospital.
Twelve hours later, we arrived at the hospital. "Liz was breathing on her own, but her expiration's were being assisted by forceful pressure through the mask. She was non-responsive. There was no grasping when her hand were held, no indication that she heard those around her.
Everyone was prepared to remove life support once the physicians agreed that although they did not know exactly what had happened, the length without any response to a multitude of medicantions and treatments seemed to indicate that "Liz" would not recover.
All that was needed now was the opinion of the infectious disease physician. His initial belief was that "Liz" had meningitis although this was not confirmed by spinal tap because of her unstable respiration's. The physician entered the room and said, "we need to triple the dose of the antibiotic and keep an eye on your mother for that time." Not unlike the time they had just spent with their father and although this plan of action seemed like grasping at straws, the decision was made to try the increased dosage of medication.
One daughter remained at the hospital while we all went home. The phone rang at 3 AM and we were told to "come now, Mom's worse." The seven children stood around their mother's bed and could barely watch her struggle for each breath. They asked the nurse what would be necessary to have "Liz" removed from any life suppport. She said that the three principal physicians who were caring for her would have to see her and that her primary physician would have to agree to remove life support.
What a long and painful day. Finally, the infectious disease specialist visited "Liz." His response to withdrawing life support was that "the medication hasn't had time to work." He did say that there "might" be some other process going on her her brain but that the neurologist would have to address that! When the neurologist arrived, he agreed that this was not simply meningitis or some other infection, but other brain malfunction as well. Although he didn't firmly say, Yes, stop treatment, he did indicated that there was a good chance that this was not reversible.
About 1PM the last physician visited. He didn't say "Yes, stop treatment," but when asked directly about the possibility of recovery, he responded, "I don't believe that she will improve or recover." Once the necessary physician orders were written to remove the forced oxygen and the medications and to provide comfort rather than curative care, "Liz" began her last decline.
About 7 PM, we were called to CCU and told that "Liz" was being moved to a private room on one of the medical units. There the family would have room and privacy. We were asked to wait in the CCU waiting room while "Liz" was prepared for transfer. The wait was at least 45 minutes. Finally we saw the bed with a nurse and the eldest daughter coming down the hallway. We took the next elevator up to the to the medical floor. As we looked at "Liz" we all noticed how still she was and how dusky her face appeared. "Liz" had died, probably in the elevator! She could have had everyone with her as they were with her husband two weeks earlier, but there was such a move to get her out of CCU now that she was dying!!!!! Liz died two weeks to the day of her husband's death. Her funeral and burial are now following that pattern.
Compassion has no place in the natural order of the world which operates on the basis of necessity. Compassion opposes this order and is therefore best thought of as being in some way supernatural.~John Berger
I would take this quotation even further to say "perceived" necessity. Unless someone was going to suffer or die without the room in which "Liz" was dying, what justified moving her? What was the rush? Did anyone consider the comfort she might have had by having all of her family continue to surround her, rather that be taken across the entire hospital and placed in room that she did not even live to occupy?
Twelve hours later, we arrived at the hospital. "Liz was breathing on her own, but her expiration's were being assisted by forceful pressure through the mask. She was non-responsive. There was no grasping when her hand were held, no indication that she heard those around her.
Everyone was prepared to remove life support once the physicians agreed that although they did not know exactly what had happened, the length without any response to a multitude of medicantions and treatments seemed to indicate that "Liz" would not recover.
All that was needed now was the opinion of the infectious disease physician. His initial belief was that "Liz" had meningitis although this was not confirmed by spinal tap because of her unstable respiration's. The physician entered the room and said, "we need to triple the dose of the antibiotic and keep an eye on your mother for that time." Not unlike the time they had just spent with their father and although this plan of action seemed like grasping at straws, the decision was made to try the increased dosage of medication.
One daughter remained at the hospital while we all went home. The phone rang at 3 AM and we were told to "come now, Mom's worse." The seven children stood around their mother's bed and could barely watch her struggle for each breath. They asked the nurse what would be necessary to have "Liz" removed from any life suppport. She said that the three principal physicians who were caring for her would have to see her and that her primary physician would have to agree to remove life support.
What a long and painful day. Finally, the infectious disease specialist visited "Liz." His response to withdrawing life support was that "the medication hasn't had time to work." He did say that there "might" be some other process going on her her brain but that the neurologist would have to address that! When the neurologist arrived, he agreed that this was not simply meningitis or some other infection, but other brain malfunction as well. Although he didn't firmly say, Yes, stop treatment, he did indicated that there was a good chance that this was not reversible.
About 1PM the last physician visited. He didn't say "Yes, stop treatment," but when asked directly about the possibility of recovery, he responded, "I don't believe that she will improve or recover." Once the necessary physician orders were written to remove the forced oxygen and the medications and to provide comfort rather than curative care, "Liz" began her last decline.
About 7 PM, we were called to CCU and told that "Liz" was being moved to a private room on one of the medical units. There the family would have room and privacy. We were asked to wait in the CCU waiting room while "Liz" was prepared for transfer. The wait was at least 45 minutes. Finally we saw the bed with a nurse and the eldest daughter coming down the hallway. We took the next elevator up to the to the medical floor. As we looked at "Liz" we all noticed how still she was and how dusky her face appeared. "Liz" had died, probably in the elevator! She could have had everyone with her as they were with her husband two weeks earlier, but there was such a move to get her out of CCU now that she was dying!!!!! Liz died two weeks to the day of her husband's death. Her funeral and burial are now following that pattern.
Compassion has no place in the natural order of the world which operates on the basis of necessity. Compassion opposes this order and is therefore best thought of as being in some way supernatural.~John Berger
I would take this quotation even further to say "perceived" necessity. Unless someone was going to suffer or die without the room in which "Liz" was dying, what justified moving her? What was the rush? Did anyone consider the comfort she might have had by having all of her family continue to surround her, rather that be taken across the entire hospital and placed in room that she did not even live to occupy?
Monday, September 28, 2009
One breath from death
Imagine standing at the bedside of an 80 yr. old man who has been diagnosed with ALS (a progressive, debilitating disease that destroys nerves and weakens muscles until breathing is impossible without assistance while the mind remains clear). Despite his weakness, he makes the same repetitive movements with this hands, until one of his daughters asks, "Do you want to write something, Dad?" He nodded and his daughter held a clipboard and paper while he slowly and clearly wrote, "Let me die." This is John's story of the poverty that our medical professionals are capable of inflicting on those who need them the most and the anguish that accompanies those "professional" decisions and actions. That poverty was diminished by the love, faith, and determination of John's family.
"John" had been rushed to the hospital from a nursing home when he experienced difficulty breathing. All but the most important paperwork accompanied him. There was nothing that mentioned ALS! Soon it became essential to assist John's breathing and the physicians explained that he needed to be intubated in order to receive enough oxygen to sustain life. Despite his advance directive stating "Do NOT Resuscitate" John indicated his permission to intubate and to place him on a ventilator.
Those who were with John when he wrote his request to be allowed to die, immediately asked for a meeting with his primary ICU physician. The following morning, five of John's sons and daughters gathered with the physician and showed him the clearly written request. They inquired as to how the removal of life support would progress. "John is receiving a great deal of sedation; I can't simply remove the endotracheal tube. Just think how John had still been able to walk and push your mother in her wheelchair even the morning that his difficulty breathing began" (a paraphrase of the physician response).He indicated that he would have to ask John if removal of the tube and ventilator was what he REALLY wanted.
The physician and John's family re-grouped in John's room. Standing over John and nearly shouting his words, the physician began by asking John how he was doing; he blinked his eyes. " Do you want that breathing tube taken out? You know we have turned down the ventilator so that you are taking the breaths and the machine is providing the force to breathe out for you. It's possible that you can return to pushing your wife in her wheelchair and resume your activities at the nursing home if we give this treatment time to work. So, do you want us to remove the breathing tube?" "DO YOU WANT TO DIE?" John looked at him and shook his head "No." Back in the conference room, the physician told the family that John had made the decision that he was obliged to honor and that he would remain on the ventilator.
John developed pneumonia. The medical plan was to perform a tracheotomy and an insertion of of a feeding tube through his abdominal wall and which would remove the endotracheal tube and present feeding tube and be more comfortable for John. The morning that the procedures were scheduled, John spiked a fever which did not respond to medications. Early in the afternoon, when the family visited him, John was on a cooling pad (the length of his body). He was shivering and trying to move his legs off the pad. It was obvious that he was miserable. John's gestures were frantic; the look in his eyes was one of confusion as to what was happening to him.
Several days later, John's fever was under control, but his pneumonia had worsened. He appeared to be weaker and he slept more that he was awake. He continued to initiate breathing, with the ventilator assisting in expiration. Once again, the family asked to speak with the physician. He agreed that John might require the respirator for the rest of his life. His family asked if the nursing home would let him return on a respirator and he indicated that they would not. They inquired as to where there might be a facility nearby that would take John. There was a nursing facility that would take ventilator dependent individuals for rehab. The longest he could remain there was a month! What then?? Was there a facility for long term placement? The nearest nursing home able to care for someone on a ventilator was more than an hour's drive away. His wife would only be able to see him occasionally.
Once again the family gathered together to discuss the options for their father and husband. They approached the physician the next morning with their decision to have John gradually weaned from the ventilator and to let him die in peace. This time, as the physician spoke to John, he told them how serious his condition was and that there was a great probability that he would never be able to live without a respirator. The two possibilities that he explained to John were remaining on the respirator or keeping him comfortable while respirator assistance was gradually lessened and he died. John signaled that he understood and plans were made to begin the process within the hour.
As the gradual reduction in ventilator support began, a priest friend of his family had been asked to pray with them. Everyone was gathered around the bed and the image of a large group of people, each wearing white garments and gathered before God was recalled from the Revelation to St. John the Divine. When asked who these people were, an elder responded that they were the ones who had passed through the great tribulation. John was assured that he, too, would soon be one of that multitude standing before God who would say to him, "Well done, good and faithful servant." John's monitor indicated the slowing of his heart rate and the lowering of his blood pressure. Everyone present had the opportunity to hold John and tell him how they loved him. Peacefully and painlessly, John slipped into the open arms of God. As the monitor indicated cessation of life, the priest began, "Eternal Rest grant unto John O Lord....." and the prayers of the family began as John was held in their loving arms and committed to God's care.
The first question which the priest and the Levite asked was: "If I stop to help this man, what will happen to me?" But... the good Samaritan reversed the question: "If I do not stop to help this man, what will happen to him?" Martin Luther King, Jr.
John's family never asked the question of the priest and the Levite. Although it was not verbalized, I sense that this was a huge question for the physician. Had John's family not been attentive to his wishes, he would be in some nursing facility; away from family and friends. He would not be able to speak and would be totally dependent upon others and machinery to sustain "life." John has moved now from the poverty of illness, fear of lawsuits that often dictate medical decisions, and total dependence upon others to a new life in the Presence of God.
"John" had been rushed to the hospital from a nursing home when he experienced difficulty breathing. All but the most important paperwork accompanied him. There was nothing that mentioned ALS! Soon it became essential to assist John's breathing and the physicians explained that he needed to be intubated in order to receive enough oxygen to sustain life. Despite his advance directive stating "Do NOT Resuscitate" John indicated his permission to intubate and to place him on a ventilator.
Those who were with John when he wrote his request to be allowed to die, immediately asked for a meeting with his primary ICU physician. The following morning, five of John's sons and daughters gathered with the physician and showed him the clearly written request. They inquired as to how the removal of life support would progress. "John is receiving a great deal of sedation; I can't simply remove the endotracheal tube. Just think how John had still been able to walk and push your mother in her wheelchair even the morning that his difficulty breathing began" (a paraphrase of the physician response).He indicated that he would have to ask John if removal of the tube and ventilator was what he REALLY wanted.
The physician and John's family re-grouped in John's room. Standing over John and nearly shouting his words, the physician began by asking John how he was doing; he blinked his eyes. " Do you want that breathing tube taken out? You know we have turned down the ventilator so that you are taking the breaths and the machine is providing the force to breathe out for you. It's possible that you can return to pushing your wife in her wheelchair and resume your activities at the nursing home if we give this treatment time to work. So, do you want us to remove the breathing tube?" "DO YOU WANT TO DIE?" John looked at him and shook his head "No." Back in the conference room, the physician told the family that John had made the decision that he was obliged to honor and that he would remain on the ventilator.
John developed pneumonia. The medical plan was to perform a tracheotomy and an insertion of of a feeding tube through his abdominal wall and which would remove the endotracheal tube and present feeding tube and be more comfortable for John. The morning that the procedures were scheduled, John spiked a fever which did not respond to medications. Early in the afternoon, when the family visited him, John was on a cooling pad (the length of his body). He was shivering and trying to move his legs off the pad. It was obvious that he was miserable. John's gestures were frantic; the look in his eyes was one of confusion as to what was happening to him.
Several days later, John's fever was under control, but his pneumonia had worsened. He appeared to be weaker and he slept more that he was awake. He continued to initiate breathing, with the ventilator assisting in expiration. Once again, the family asked to speak with the physician. He agreed that John might require the respirator for the rest of his life. His family asked if the nursing home would let him return on a respirator and he indicated that they would not. They inquired as to where there might be a facility nearby that would take John. There was a nursing facility that would take ventilator dependent individuals for rehab. The longest he could remain there was a month! What then?? Was there a facility for long term placement? The nearest nursing home able to care for someone on a ventilator was more than an hour's drive away. His wife would only be able to see him occasionally.
Once again the family gathered together to discuss the options for their father and husband. They approached the physician the next morning with their decision to have John gradually weaned from the ventilator and to let him die in peace. This time, as the physician spoke to John, he told them how serious his condition was and that there was a great probability that he would never be able to live without a respirator. The two possibilities that he explained to John were remaining on the respirator or keeping him comfortable while respirator assistance was gradually lessened and he died. John signaled that he understood and plans were made to begin the process within the hour.
As the gradual reduction in ventilator support began, a priest friend of his family had been asked to pray with them. Everyone was gathered around the bed and the image of a large group of people, each wearing white garments and gathered before God was recalled from the Revelation to St. John the Divine. When asked who these people were, an elder responded that they were the ones who had passed through the great tribulation. John was assured that he, too, would soon be one of that multitude standing before God who would say to him, "Well done, good and faithful servant." John's monitor indicated the slowing of his heart rate and the lowering of his blood pressure. Everyone present had the opportunity to hold John and tell him how they loved him. Peacefully and painlessly, John slipped into the open arms of God. As the monitor indicated cessation of life, the priest began, "Eternal Rest grant unto John O Lord....." and the prayers of the family began as John was held in their loving arms and committed to God's care.
The first question which the priest and the Levite asked was: "If I stop to help this man, what will happen to me?" But... the good Samaritan reversed the question: "If I do not stop to help this man, what will happen to him?" Martin Luther King, Jr.
John's family never asked the question of the priest and the Levite. Although it was not verbalized, I sense that this was a huge question for the physician. Had John's family not been attentive to his wishes, he would be in some nursing facility; away from family and friends. He would not be able to speak and would be totally dependent upon others and machinery to sustain "life." John has moved now from the poverty of illness, fear of lawsuits that often dictate medical decisions, and total dependence upon others to a new life in the Presence of God.
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