Critical Care

By Terry A. Davis

This text is from a sermon given to Mountain Light UUC on 2008 November 09 and was kindly provided by the speaker.

There isn't a day that goes by at Crawford Long Hospital in Atlanta that I don't ask myself, "Why am I here?" At 48 years old, my journey from a marketing and communications professional to seminary student to hospital chaplain has the sure-fire markings of a mid-life crisis.

"Why am I here?" I ask myself, as I travel the corridors of the hospital at 2:00 AM, responding to a nurse's page that a patient has died and the family wants pastoral support. "What words of comfort can I possibly say that won't sound tired, trivial or tentative?"

Suffering and death are everyday occurrences at my new place of work. It's a far cry from the stress of running a graphic design agency – my former job. No one ever died from a creative idea that bombed or a deadline that was missed (although, judging at times from my own overwrought anguish over some mistake our agency made on a client project, you would think that I was on my way to death's door).

No… if working at the hospital as a resident chaplain has been anything, it has been an ego-leveling and priority-adjusting experience. And, thus, it is serving as an unexpected and profoundly important leg on my spiritual and vocational journey.

In our reading this morning, 20th century Buddhist Nun Ayya Kehma presents her definition of skillful living. She explains it as the ability to transcend one's bodily and mental suffering by connecting to what she refers to as "contentment in the heart." Keyma [kay-ma] tells us that at the base of this contentment is "the understanding that giving love and approval creates a field of harmony around oneself."

In other words, giving love and approval to others is actually good for our spirits. This teaching is an age-old one, found in many religious traditions and moral codes. Likely each of us have experienced a deep feeling of satisfaction when we take time out to help someone else – without any vested interest in the outcome or in a payback.

Yet, if we are familiar with this concept, why is it so difficult for many of us to hold on to a sense of contentment (which I would also define as inner peace)? Why does a dead car battery, a fussy child or a long line at the Kroger check-out counter zap our contentment so readily – like a sharp pin popping an inflated balloon?

My belief – and my message to you this morning – is that our ability to give love and approval to others is an outgrowth of the critical care we provide to ourselves. Rather than being self centered, I believe that critical self care is self preserving.

It is a commitment to nourishing our minds, bodies and spirits so that we are best equipped to deal with challenges in our own lives.

Critical care of the self, when practiced in a thoughtful and non-indulgent manner, makes it more possible for me to engage in selfless loving of others and achieve Kehma's contentment in the heart. Those interpersonal connections with others that are characterized by love and fostered by a balance of self care and self giving have provided me with opportunities to walk on the holiest of ground – that is, to connect with another human being in truth and in intimacy.

My understanding of what it means to practice critical care has been and is still a hard-won lesson. Like many of the chaplains at Crawford Long Hospital, my decision to accompany others in their suffering and path to wellness was sparked by my own physical and spiritual sickness and recovery.

I grew up in a middle-class family in Washington, DC, the oldest of three daughters. My Catholic Italian American father and Episcopalian mother were each 19 years old, broke and ill-equipped for parenthood when I entered their lives.

While we were a family that maintained frequent connections – holidays, birthdays and Sunday afternoons were usually characterized by gathered relatives and family meals together – we were also a family that struggled with alcoholism, domestic violence, depression and financial strain.

My father, who was a high school graduate and was working as a junior programmer for IBM in the early 1960s, was under enormous pressure to provide for my mother, my two sisters and me. Arguments between my parents about money and where it was spent were common in our home.

My grandparents worked equally hard for the little income they earned. My Italian grandfather bounced around at various jobs most of his adult life, including working at his cousin's funeral home where he might be called at a moment's notice to drive out of town to pick up the body of a recently deceased person. My Italian grandmother cut leather soles in a shoe factory. My maternal grandmother – a widow since my mother was nine years old – worked as a bookkeeper for the Maryland Department of Education and was paid a steady, if modest, income.

Self care as you and I probably understand it was a non-existent concept for my grandparents and – until more recently – my parents. Rather than self care, they were most concerned about survival – food on the table, clean and presentable clothes to wear and keeping the rent paid. In my own family, it was only after I reached my teenage years, that my father's income had improved to the point that he was able to purchase our family's first home and we had our first family vacation at nearby Ocean City, Maryland.

Self care can seem like a self-ish thing – particularly when I am so keenly aware of the needs of others around me. This is something that we discuss often in the hospital setting. I find that taking time off the hospital floor to sit and rest, to read something soothing or to share a few laughs with colleagues in the office is so important.

In fact, it is in these lighter and humorous moments with my co-workers and friends that I gain a deeper appreciation of the range of emotions and experiences that make me human. It is these spontaneous bursts of humor and joy that I believe build my resiliency for more difficult times ahead.

In her national best-selling book, "Here if You Need Me," Unitarian Universalist Minister and Chaplain Kate Braestrup sprinkles her own sense of humor within and among moving personal reflections of her experiences as a Maine Warden Service Chaplain and of her journey of grief and healing following the accidental death of her husband Drew. While it is clear in Braestrup's story that she was profoundly affected by the loss of Drew and of those who died tragic deaths in the Maine forest, her moving and funny memoir also embodies the spirit of someone whose off-beat humor is her source of self care.

Humor is Braestrup's way of balancing both suffering and joy, heartache and healing.

In one passage, Braestrup recalls the cremation of her husband Drew and the quirky conversation and sobering observations that took place at the crematory. She writes:

Drew wanted to be cremated.

"I want to attend the cremation," I told Mr. Moss.

"All right," he said.

"I shall stay for the whole thing," I said, "beginning to end."

"Of course," said Mr. Moss.

"I'll carry his ashes home myself," I said.

Mr. Moss gently inclined his head in a sort of bow.

"Of course," he said again.

I wore a dress Drew liked the day I accompanied his body to the crematory. It was our last date, in a way. Mom came with me, along with Drew's friend Billy, and Drew's father and stepmother. Cremating someone is manual labor. The same two guys who mow the lawns, weed the flower beds, clip the hedges, and dig the graves at Parklawn also burn the bodies. They wear work boots and hats emblazoned with beer company logos. They seemed to be agreeable fellows, but they lacked that soothing, avuncular, funeral-parlor mien one grows used to in the days surrounding a death. Briskly, they rolled the trolley over to the oven door.

"This is going to take a while," one of them warned me.

"We're talking four, five hours – young guy like this here."

"Big fella too," the other one agreed. "Could take five and a half."

"An older person you can sometimes do in three. Their bones break down faster," one of the workers was saying. "Even in four hours, the big bones – your pelvises, your femurs – they don't burn. They pretty much stay as is."

"Then what?" my mother asked, clearly picturing someone trying to jam a half-burned pelvis into an urn. What do you do with the big bits?"

"We grind them up in that grinder," the guy said, pointing to what looked like an oversized Waring blender. "And then put 'em back in with the ashes. It works really well," he assured us, mistaking our bemusement for skepticism.

"Grinds everything up nice." Billy wandered over and casually inspected the grinder, just to make sure that there wasn't too much of anyone else in there who might get blended in with Drew.

Somewhat too quickly, one of the workers opened the big stainless steel doors to reveal a smaller cast-iron door. It looked like the door of a woodstove or the door one sees in pictures of the crematories at Auschwitz, though we tried not to notice the resemblance. He opened it, and behind it was a smallish brick-lined oven not a whole lot larger than Drew's coffin.

The workers pushed the box into the oven.

"So long, my buddy," Drew's dad said.

"I will see you in my dreams," I said.

Not everyone possesses Kate Braestrup's knack of walking along the shores of tragedy – feet plunging into the ice-cold waves of grief, while outstretched fingers skip the surface of the water, making playful splashes.

Ayya Keyma calls giving love and approval – which leads to one's contentment – skillful living. I would expand the definition of skillful living to include being able to show up for pain and simultaneously leave room for joy.

Joy in the midst of suffering may manifest as laughter, as was the case for Reverend Braestrup. It may also occur as an experience of transcendence – as if one is being transported from the sharp edges of suffering to a place of profound intimacy and connection.

I believe I have had a few such remarkable moments at Crawford Long Hospital – where I was able to be in solidarity with someone's pain and also experience a deep connection. One moment that stands out for me in particular was an encounter I had with a patient I'll call Mr. Carter.

I met Mr. Carter during my rounds one Sunday. The first thing I noticed about him when I entered his room in the ICU were his glasses. They just seemed too big for his face. They were tortoise-shell frames in a square, sort of 1980's style.

He looked like he was in his 40's. His medical chart said he was 50.

There was something boyish about his appearance – his eyes were large and his cheeks were chubby. The sheet that covered the upper half of his body fell flat after reaching his hips. I knew what that meant. His hands were wrapped in bandages and he held one out to me to shake my hand when I approached his bed in the ICU.

He asked me questions about my role and my religion. He was pleasant, but not happy. He was disturbed, but not angry. He said he had no value.

"A man's gotta work," he said, "or he has no value. I don't work anymore. I used to work for a big company, but not any more. I have no value."

With each part of his body that Mr. Carter had to give up – first one leg, then the other and then fingers, one at a time – Mr. Carter seemed to believe that he was becoming more and more insignificant as a person.

I initially invited Mr. Carter to expand his definition of value, but I soon regretted suggesting this. Standing on my own two legs with all fingers and parts intact – how could I say anything meaningful?

Then Mr. Carter made a surprising request: he asked me if I would serve him communion.

Mr. Carter was Catholic. I was raised Catholic and the request reminded me of the reasons why I had left the church – most of them, ironically, having to do with issues of my own value.

Just as Mr. Carter felt the corporate world has no use for a man with no legs and chronic health issues, I similarly felt that there was no place in the Catholic Church for me – a lesbian. Serving him communion was surely out of the question.

I offered instead to call a local priest to administer it. Yet, the priest never came. And, the following morning, when I went to check on Mr. Carter, he asked me again to serve him communion.

"Mr. Carter," I said, "I'm not a priest. The act won't have the same value if I do it."

"It will have value to me," he replied. "Please…"

After leaving his room for several minutes, I reappeared with communion wafers and grape juice in hand. I had located an Episcopal Eucharistic liturgy.

Mr. Carter was ready to receive the body of Christ. For my part, I was prepared to join Mr. Carter in a communion of value – where gender, religion, sexual orientation, and physical ability made no difference. In that moment, our mutual pain of exclusion was transcended. Instead, we found joyful mutuality in our humanity. We were two people who connected in suffering and in grace.

I would like to think that my ability to provide critical care that day was, in part, influenced by the care with which I have been attempting to give myself.

Questioning old beliefs. Searching for truth and meaning. Living openly and authentically. Paying attention to the needs of my body for good food and rest. Nourishing my spirit with good music and warm friendships.

These are some of the ways I care for myself so that I may be better able to meet the sacred when it greets me in the space between joy and pain.

Critical care of myself provides me with the resiliency that so miraculously shows up when accompanying others in their suffering. And critical care of myself permits me to greet my own pain with respect and reverence as I peer into the darkness of my own soul.

My hope for each of us is that we can participate in what Ayya Keyma refers to as the art of skillful living – where we are giving critical care to others from a place nourished by self care.

May we find the courage and conviction to do so. For our sake and the wellness of us all. Amen.