They Sat on the Ground with Him.

When my father had his heart attack, the family rushed to Cleveland to sit by his bed and congregate in the waiting room outside of the cardiac wing of the Clinic. We waited for two days: through his stabilization in the emergency room, the initial assessment and first battery of tests, the consults with specialists, and finally the intervention. His surgery was actually delayed by a few hours because Robin William's cardiac surgery was taking longer than expected and they shared the same doctor. In spite of that, Dad made it home safe and sound and a few years have gone by in relative cardiac heath, minus the salt and extra gravy.

From that, the Vega family learned to appreciate the phrase, "as serious as a heart attack." As bad as it could have been, it's amazing how far medical technology and treatments have advanced in the last few years, let alone the last twenty. They now not only stop your heart and divert all blood from your chest to a machine, they cool your body down to morgue temperatures only to revive you after the surgery with a slow thaw. All that in the name of progress and a few extra saved brain cells. 

Despite all the progress and advances made in medicine, things that were unthinkable even a few years in every field of science, nothing still spells terror like the diagnosis of cancer... and, at Grace Fellowship Church (and in my own life), we have had more than our fair share or cancer cases; some of them very recent and still ongoing. What do you say to someone who is actively suffering the diagnosis, treatment, and uncertainty of cancer? For that matter, what do you say or do for anyone who is suffering real anguish and pain?

In the first few chapter's of the Biblical book of Job, the writer describes an ongoing bet between God and Satan regarding the namesake of the book and the horrible series of events that befall him. "But stretch out your hand and strike everything he has, and he will surely curse you to your face."

Consequently, all of his belongings are stolen, his children die in horrible accidents, and his own body is stricken with "painful sores from the soles of his feet to the top of his head." Nothing is left except his life, but even his quality of life is destroyed. His friends could hardly even recognize him when they see him for the first time after all of this had happened. If you've seen anyone who has undergone chemotherapy, has been slowly wasting away, or has an advanced liver disease, you may have a better understanding of how Job looked to his friends, shocking.

For all of the commentary indicting the three friends (Eliphaz, Bildad, and Zophar) for their presumptuous commentary in later chapters, I think the final paragraph of chapter two (had it been all they did) is the most beautiful example of friends offering solidarity in regards to the suffering of a friend and loved one:

"When Job’s three friends, Eliphaz the Temanite, Bildad the Shuhite and Zophar the Naamathite, heard about all the troubles that had come upon him, they set out from their homes and met together by agreement to go and sympathize with him and comfort him. When they saw him from a distance, they could hardly recognize him;they began to weep aloud, and they tore their robes and sprinkled dust on their heads. Then they sat on the ground with him for seven days and seven nights. No one said a word to him, because they saw how great his suffering was."

What do they do? Nothing that seems heroic, but it is amazing.

1. When they hear about Job's suffering, they gather together and go to check on him. 
2. When they see his suffering, they show genuine emotion and concern.
3. Without explanation or rationalization, they share in what they can of his suffering. They sit with him. 

How often do we make the later mistake of the friends and open our mouths to pontificate... when what we should be doing is the simplest of acts, just being with the one who is suffering?

Let them speak if they choose. Let them ask if needed. If they do, then speak or act. Be patient, open, and available. That's the amazing part we all too often forget and, because of that, end up doing more harm than good.     

I may never know or fully understand the true magnitude of anyone's suffering, but I can share in it and sit on the ground with them. 

Dying, But No Faster Than the Rest

I've done it before, but it never seems to get easier: They ask, "How is my [loved one] doing?"

I reply, "How much do you know?... They're dying."

Some of them know it, but can't say it. Some of them get blind-sided. Some of them just cry. None of them react the same, but they all get that look on their face when the light-bulb goes off in their mind. That tears me apart, the moment they see the expiration date on their loved one peaking out from the blanket at the foot of the bed.

I've given up giving false hope, agreeing with the thousand excuses and miraculous scenarios the person asking is hoping I'll tell them. Yes, I believe, but I've seen death more than miracles and the signs are often clear... if you choose to see them. The trick is in how you show them, prepare them, bring them together and help them navigate the inner (and sometimes outer) fights.

They think I'm the expert, not the loved one who's ready to let go and be with their long dead spouse. Sometimes, the patient just knows they can't hold on and is looking for permission from the loved one. In the midst of that, I'm supposed to be the sign post or the weather channel, the portent that signals life or death, the one to tell the family (often) what they already know.

I have to be the first to say it, to make it real or banish all the fears. What's more, the family never wants to ask it in the room or in ear-shot of the patient. They seem to think it's escaped the patient, the one lying in bed. They say things like, "Let's not talk too loud just in case they're listening."

Who? The patient, angels, death?

Even if family never shows up, I know. I mourn. I carry it with me. Each one sticks with me. Each one makes me remember my own mortality and the ones I'll leave behind.

Some nurses get drunk, some get mean, and (worst) some go numb. Personally, I write and always cry, not in front of the family, the lover, the friend, the rest of whoever, but I do cry. I've cried in the stairwell, the break room, the locker room, in bed, or at the solitary bedside of the comatose patient while doing my assessment or hanging medication. I've struggled with God. I've yelled at God in the car before going in the house late at night to go to bed. I've lost faith and gone down dark roads.

But I come back. So far, I've always come back. Sometimes all I can do is put one foot in front of the other until I can look up again, but I look up again. That's what I tell them: the patients and their loved ones. Not all of it, but enough to let them see I care and know a bit of what they feel. Forget the tag you see hanging off the patient's toe or the one you infer on your own toe.

We ask, "Will I ever see this person again, or do I lose them forever? What about my other loved ones? What is the point? What am I doing with my life? When will I die?"

When we're honest with ourselves, we answer, "Yes. We will die. Maybe no faster than the rest, but we are all going to die."

The moments before imminent death, that infinitesimal point in eternal history, make us question life and after. It can rip your psychological well being from its roots. It happens to the patient. I'm sure it's happening to the loved ones I interact with at the hospital. It happens to me, but experience lets me weather the storm with a strong face. At some level, we're all going through the same questions, anxiety, and angst.

What can you do? What can I do?

So far, nothing I can do as a nurse providing care, administering medications, observing what is happening and trying to anticipate what will happen can do anything more than delay the inevitable. Nothing the doctor can do as a physician can stop the end. No amount of family bickering, anger, bargaining, or finger-pointing can affect the past, but we can affect the present.

Discuss what's bothering you, be open, enjoy the moment. Spend now with who you can, when you can. Tell the air if you have to. That's all you can do, but you can miss the opportunity to do it.

Nurses know. Doctor's know. Your loved one who's dying probably knows better than all of us. Do you?

Don't Believe in Charms

The second greatest gift that God gave man is "common grace." Everything good comes from God and He is not limited in His means or by whom He chooses to use.

The theologian Calvin expressed it thus, "that we... cannot do any thing that is good without thee [God]." Even a non-believer glorifies God by their good intellect and/or the products of their hands. Their skill, music, writing, thoughts, actions, and even that which they don't do is temporarily elevated, allowed to exist in a greater plan of good. 

So... Why do some choose to put the Ichthys on their business cards? Is it in hopes of elevating their work? I find that is hardly the case. Instead, quite the reverse. It is used to lull those that think of the symbol as a charm, a speak-easy knock, the secret knowledge that will ensure an honest job from the person who's card it's on. Only charlatans have need to lull their prey and only the naive should believe it.

"Show me your faith without deeds, and I will show you my faith by my deeds." I don't need a charm, nor do I care for those who do. Any reminder I carry is for myself.




  

Glass Aquariums

I feel a compulsory need to gain their attention, talk to them, and then... tamp them down, slow their role, control their outbursts. Why?

He came to church. For Easter, he got dressed up and came to the church he remembers. He was late, but, then again, we've changed times since he was there last. He sat next to a guy he knew and we talked during one of the songs. The conversation wandered from a smiled greeting, to the bike trail, to the song we were singing, to the woman up front at the microphone.

He made me nervous. I waited for the tell tail sign that makes our conversations awkward. Sooner or later, the other shoe always drops. It always has. His neural circuitry tends to loop in inappropriate areas and I have to fight the associated embarrassment when the tic comes out.

Why not say it? They make me nervous, but, as people, I find them (him) engaging. As a medical professional, I find them (him) interesting, fascinating.

I had spent the last four days on a family vacation with my daughters and wife. On the second day, we visited the Newport Aquarium and beheld the wonders of the ocean and the swamp: sharks, sting rays, a school of piranhas, a hundred year old snapping turtle, and a twenty-foot alligator. We stood and watched, tried to touch them (behind glass) as I pontificated to the girls about their habitats, life-cycles, wonders... and dangers. It was fun, it was interesting... it was safe.

Standing next to him in church, talking with him, it hit me. Why was I afraid of him? Why was I wasting all of my attention and energy trying to put a tank of glass between him and myself: to better study him? Was I treating him like a wild animal... an animal?

I was! I repented. I still had to actively focus on the worship going on. I had to force myself not to worry, but, for the next hour, I began to enjoy his presence as a fellow believer.

Social norms... the glass tank we swim in. Perhaps the glass tanks at the aquarium aren't just to protect the tourists? They protect the animals too!

Then it hit me again. I wasn't trying to protect him, I was trying to protect myself. He was as broken and forgiven as I am. He still waits and longs to be made whole again with the resurrection, but can't hide behind social norms like I can. He couldn't put on the protection like I could and he wanted to swim in my tank, sit by me, talk to me, and interact on my turf. That's what scared me. Would I have to do the same? Would I have to take down the glass wall between him and I? 

Would the others in church see my untamed side, my viciously unSunday side? The side of me that enjoys a bawdy joke, that enjoys an occasional beer, that connects and (more than that) empathizes with his daily struggle?

Yes and yes.

I still have boundaries, especially with my daughters in the seats beside me, but I did, will, and do want to swim with the other fish.

The first step: I will not be embarrassed. I will deal with it as it comes... if needed, but not before. I will not be "anxious about anything, but in every situation, by prayer and petition, with thanksgiving" enjoy the people God puts in my life.

As my older patient's tell me when I ask them, "live life while you can and live it now." Damn the glass tanks!

Forget the Fig Leaf, Gird Yourself Like a Man

Of all the people in history that might have had a reason to complain, I would have given Job the benefit of the doubt. Adam, not so much:

Lone survivors tell of "fire from heaven,... raiding parties, ... [and] a mighty wind from the desert" that destroy everything dear to him.  Job losses his family and everything he owns. His progeny and their inheritance, his portion of Abraham's covenant with God, gone. His outer safety net of relationships go with it.

At the loss of everything he owns Job "did not sin by charging God with wrongdoing" and, after the loss of his health, Job "did not sin in what he said."

Then, his friends begin to eerily echo the words of the serpent in Genesis:

[Eliphaz speaks-]

A spirit glided past my face,
    and the hair on my body stood on end.

It stopped,
    but I could not tell what it was.
A form stood before my eyes,
    and I heard a hushed voice:[...]

'If God places no trust in his servants,
    if he charges his angels with error[...]

Are not the cords of their tent pulled up,
    so that they die without wisdom?’

At that, a closer ring of relationships are broken. 

Later, after he's afflicted with every milady except death, his own wife encourages him to "curse God and die." Now, all of his most intimate relationships have been severed, and he begins to question God, asks many of the deep questions of life, and even curses the day of his birth: 

“Why is light given to those in misery,
    and life to the bitter of soul,

to those who long for death that does not come,
    who search for it more than for hidden treasure,

who are filled with gladness
    and rejoice when they reach the grave?" 

I imagine that, in his grief and lack of anyone to confide in, he does the only thing he can. He yells at God, the only one left. As the textbook definition of rock bottom, I'm sure the silence and isolation Job feels is deafening. As a nurse, I've seen people who have suffered less and still Job's question has come to my mind on occasion.

Still, unlike when God spoke to Elijah in the gentle whisper, after all that Job has endured, God appears forceful in his answer and, like his questioning of Adam and Eve, gets to the heart of the issue like a knife.

 

Then the Lord spoke to Job out of the storm:

“Brace yourself like a man;
    I will question you,
    and you shall answer me"

In so doing, God seeks to right the first and most important relationship in anyone's life, that of God and his individual creation. He doesn't mince words, he doesn't dilute or diminish it by asking the hearer (Job) to turn or cover his face. He even warns Job that He's going to tell him how-it-is and then force an accounting, an answer, no choice, no hiding in the garden of Eden.

[Then Adam (guarded by a fig leaf) replied to the Lord:]

“I heard you in the garden, and I was afraid because I was naked; so I hid. [...] The woman you put here with me—she gave me some fruit from the tree, and I ate it.” 

In God's mercy, Job refuses to blame his wife and answers God with none of Adam's excuses and denials:

Then Job replied to the Lord:

“I know that you can do all things;
    no purpose of yours can be thwarted.[...]

Surely I spoke of things I did not understand,
    things too wonderful for me to know.[...]

My ears had heard of you
    but now my eyes have seen you.

Therefore I despise myself
    and repent in dust and ashes.”

With Job's personal relationship with God back in order, God begins to move in the background and right Job's outer relational-rings: 

[God  speaks to Eliphaz]

 “I am angry with you and your two friends, because you have not spoken the truth about me, as my servant Job has... My servant Job will pray for you, and I will accept his prayer and not deal with you according to your folly.”

To Eliphaz's credit, he obeys God, rights his relationship with the Almighty, stops conveying the message of the shadowy figure, and then asks for Job's prayer... and Job consents.

"After Job had prayed for his friends, the Lord restored his fortunes and gave him twice as much as he had before."

In this instance, Job's restoration appears to hinge on Eliphaz's personal obedience and Job's blind acceptance of his friends' public offering of regret. Does the idea that someone else's restoration may be riding on your obedience make you uncomfortable? I think it's meant to.

Next time you sin toward someone (even if well or unintentioned), don't hide behind the fig-leaf and wait for God to come calling for you. Gird yourself like a man. Obey and ask for forgiveness like Eliphaz; don't give excuses like Adam.

If anyone asks you for forgiveness, man up like Job (I doubt you have it worse), and extend obedient forgiveness. Don't point fingers, like Adam, at the very relationships and circumstances that you have been blessed with.

It is also worth noting that Job never gets his first children back; he still has to deal with his grief and real hurt, but he does so with the confidence that his relationships have now been righted and confirmed.

“Naked I came from my mother’s womb,
    and naked I will depart.
The Lord gave and the Lord has taken away;
    may the name of the Lord be praised.”

All the rest flows from that.

My Oldest and I

She's the one with the quick and quiet wit that waits in line for the right moment to strike and comes out swinging for the fences only to retreat back into her shell with a blushing smile and a glint in her eyes that tells me she is proud and pleased with what she's done and the reaction that she saw register on my face. 

Two years waiting for her to take root and grow, it seemed I already knew her when she came out and grabbed my finger for the first time, wrapped around my finger and my heart.

My second love. I read to her; I played with her before she was born, a game of run and tag, her foot kicking at the light I used to tease her with against her mother's stomach. Her heat permeated anyone she touched enticing them to be the cushion that she slept on, contoured memory foam for her to grow on, she had her pick of human mattresses to protect her as she napped.

Whatever she wanted, she got. Not to spoil her or to make excuses for a lack of attention or to excuse or cajole behavior, but to see her smile and squeal, her eyes light up with joy that someone thought of her and knew just what she wanted. It wasn't hard; she never hid it. You just had to give her clothes to deconstruct and rebuild into her world.

Even at six, she lived for expression, in fashion, in school, in paint, and dance. Her cloths, her socks, they never matched. Why should they? She rejected the matches others made (she didn't know them) and made her own. Intensely loyal and acutely attuned to others'  feelings, she cried for others' pain and stood up for the rejected, sometimes sobbing in the car on the car ride home. She didn't even match her friends, but they still flowed together.

Her parties rocked and she would float between the groups of dance, or school, of church, of camp: lace, books, glasses, and camo. From movies under the stars, make-up in the room, and stages built to dance on, move on, she shined with everyone on whatever stage we built for her and put her on.

I've danced with her. It was best at the "princess balls," costume required. I was her prince, the king, and dinner date before dancing on the floor to music way too loud for both our ears. The first time, she danced with me alone and held my hand when friends came. A circle would ensue; we'd dance together. A hop with fervor in the air. I was still the stage she clung to.

With confidence came willingness to leave me for a while, short trips that soon got longer as the years went by and now I stand and watch her celebrate with friends away from me, but always with an eye to see me there, see me watching, still close enough to see her need should it arise, a visible anchor if she falls.

This year she asked me something different, She wanted me to blend in with the other dads who never seem to go-all-out. They where their suits and stand by the wall sipping beer and chatting to themselves, ignoring all around them: an illusion for her friends or maybe for her own new found sense of adventure, the need to venture out. She asked it to my wife, the sounding board, the go-between, to see if it would stick. I was crushed and she quickly changed her mind, but I've watched her dance, her own creations on the stages of her choosing.

I no longer match her style. I'm no longer the visible protector, partner, father, front-stage-participant, but that's okay. I know which way she's headed. My second love is looking for her independent place, the same one I gave her the confidence to take.

She still knows I'm there. I remind her. I tell her I love her... watching, blending, and waiting should the need arise. 

Daily Pills and Shame

At six, I rode my first bike. My ever-so-slightly younger brother was already gliding the pavement without his training-wheels and I was the one left behind. motivated by shame, I vowed to catch-up and allowed my dad to teach me. I learned quick when he let go at the top of a local hill that had just been tar-and-chipped. The immanent fear of danger was a quick and efficient teacher.

At seventeen, I drove my first car. My girlfriend had started college and my friends had figured out I didn't like to pay for gas. Their was no way I was going to get caught riding the bus as a high-school upperclassman. A weeks worth of trips on the same bus as the freshman and having to get up an hour earlier to do it proved to be the breaking point for my reluctance to get a part time job and begin paying for car insurance. Again, shame drove me to take the next step in my life. 
 
As a nurse working on a hospital's chronic heart floor, I see the effects of shame. Older women who are afraid to admit they can no longer cook for themselves and end up sending their sodium and sugar levels through the roof with microwave dinners. Older men who refused to use a walker or a cane until they fell down the stairs and broke their pelvis. No one wants to admit that they may be suffering from the worst parts of getting older, dependance and physical decline. 

Today, the doctor told me what I had already known. My blood pressure is getting too high. Most of the patient's I take care of would be happy to have my numbers, but I know that the sixty-five year old I take care of during the day probably had borderline numbers like me when he was my age. What kept them from taking care of their systolic business in the 1980's? Aside from lack of information, I'm guessing it was shame. Ignorance may be bliss, but the next best thing is a good show for the rest of them. Right? 

I've seen the ravages of heart disease and high blood-pressure. I've seen proud men drown in their own fluids, their lungs filled up past the first lobe. I've seen women stroke out with a systolic pressure above 240, despite headaches, multiple visits to the ER with chest pain, and difficulty breathing. When I have time, I ask them when they started getting mild symptoms, when they noticed it (and started ignoring it); it's almost always in their 30's and early 40's. They started killing themselves in their 30's!

So, at thirty-four, I've taken my first blood pressure pill and hope the small monthly investment pays bigger dividends thirty years from now despite the shame and the admittance of the inevitable, my body isn't perfect and neither am I. They always say it's the first step. Next step, the right foods and exercise... I'm not there yet.