Holiness and Health
By Charles Rush
September 6, 2009
Mark 2: 1-12
(mp3, 7.5Mb) ]
yone involved in health care these days knows just how difficult the situation really is. About 5 years ago, I attended a meeting with the Chief Administrator at Overlook Hospital in which we reviewed three different scenarios: bad, worse, and apocalyptic. It reminded me of a commencement address given by Woody Allen many years ago in which he told the graduates: “More than at any time in history, humanity faces a crossroads. One path leads to despair and utter hopelessness. The other leads to total extinction. Let us pray we have the wisdom to choose correctly.”
I started out in
ministry as a chaplain in the emergency room at the University Hospital in
Louisville, Kentucky, in the early eighties. It was colorful work. University
was a public hospital and a teaching hospital right downtown. It was over a
hundred years old when I worked there, designed for an era before electric
lights, with large open wards that held up to a hundred patients. On those
floors you had a little bit of everything. It wasn’t unusual at all to see
policemen with prisoners. The prisoners had their legs chained to the bed and
the police guarded by setting next to them. There was always at least one
indigent fellow that was on the ward drying out. Usually they had the DT’s so
bad that they had to be tied down to the bed with towels to keep them from
hurting themselves or someone else. They had a low level moaning or kvetching
or complaining that the staff was trying to do them in for good. Some of them
could moan out for an hour at a time “help me, won’t someone help me.” Help in
this case would be a fresh bottle of MD 20/20 and a pack of smokes. No one on
the ward ever had a spare bottle, least of all the chaplains, so we heard a lot
of moaning. And there were a lot of people there that were seriously injured.
We were a regional trauma hospital, so all of the accidents with 100 miles of
Louisville were medevac’ed in to our emergency room.
I had a quick
immersion into the health care in the life of the poor in our country that
summer. Some of it was oddly humorous. The first week I was there, we had a
woman that came walking into the ER covered from her head to her waist in
blood. She stood about 6’3”, weighed in the range of 350 lbs., strode straight
ahead and demanded instant service as she was in a hurry. When the staff saw
blood everywhere, they panicked. It turns out they were all superficial wounds.
One of her neighbors owed her $50. She sent her boys over to collect payment to
no avail. She called him up and he stopped answering the phone. Finally, on
Saturday night, she needed her money to get some Malt liquor and she went over
to his house herself and began rapping on his door. And she rapped and she
rapped and hollered at him for the whole neighborhood to hear. She wasn’t
leaving ‘til he came out and gave her some money. This went on for quite some
time. I guess he had enough and opened the door with a shotgun. It was a very
light weight gauge and apparently loaded with the lightest bird shot. She
stepped back off the porch, he fired, she fell to the ground and jumped
straight up. Unfortunately for him, it was only a single shot and she was on
him before he could say boo. Got in quite a few good raps on his head. Now they
were both in the ER, with neighbors and extended family. They called the
Chaplain to keep the peace down in the waiting room. I’ll never forget asking
one of the residents exactly what I was supposed to do. He said, ‘keep them
from stabbing each other.’ The high and holy calling of pastoral ministry.
Indeed, some of them were planning a bloody revenge. It was a long night.
Most of the
time, there were just low-grade tragedies that you never really read about in
the paper because these people aren’t that interesting. One night, I got over
to the hospital to meet the ER team. They were working on a guy about my age.
At the time, I was 23.
He was laying on
the OR table in the emergency room, completely red and the doctors were taping
as fast as they could, while others were sewing. He had a gash that ran from
the bottom of his big toe, up his leg to his hip, up his torso to his shoulder,
up his neck and across his forehead. I asked the attending what happened. He
looked back at me and said, ‘He wrestled with a saw and lost.’
His wife was in
the waiting room, as tiny as he was big. She couldn’t have weighed more than
100 lbs and he was my size. She had a baby with her and another one on the way.
They were farmers from southern Indiana. He was a man of very limited
education. She was a simple, country girl, poor, uneducated. I remember
thinking that she was very accomplished but she had modest intelligence and
minimal exposure to the world.
their fields, which means that you work very hard all year and barely make more
than your produce. In my brief time in the farming community, I used to think
that sharecropping today is probably not much different than it was 130 years
cutting trees on the property. Fortunately, she’d gone with him that day. He
was on the tractor and was using a circular saw implement cutting trees. She
was nursing the baby in the truck, listening to the country radio when she
heard something awful down below.
She ran down the
hill with her baby, found the tractor still running, her husband passed out on
the ground. The circular saw had sheared a pin, the blade came loose, hit the
soil, bounced toward her husband and essentially ran right up him, cutting him
literally from toe to head.
I wish you could
have seen this little woman. She was in shock but what a tough gal. Without
wasting a minute, she put the baby down, picked her husband up, threw him on
her back, leaned down, picked up that baby and carried her husband about 400
yards up a ravine to the truck. Somehow, she pushed him up on the hood of the
truck, so that he rested on the windshield, and drove down a dirt road about 2
miles to the state highway. Did I mention that she was pregnant? Tough woman.
She parked her
truck in the middle of the highway, got out, and stopped the next car she saw.
They drove to the nearest farm, called 911 and they medevaced this guy 70 miles
to the hospital. She was sitting in the waiting room all alone, telling me this
story rather matter-of-factly. I know people that come completely unglued
because someone cut them off on the Garden State Parkway. Country people often
have this remarkable stoical way of handling these grave tragedies like this is
to be expected as part of our living.
I could not
believe that he could live. I could not believe you could lose that much blood.
But somehow that incredible team of med students sewed and sewed. It was
several thousand stitches but they sewed him up.
I saw her for
the next several days, little by little, she would tell me about her situation.
They rented. She had no people near here that could help them. His people were
largely dead. She worked and was worried that she would lose her job at the
grocery store because she had taken this time off. She didn’t want to see a doctor
but she was sore. She didn’t have a doctor for her baby. She didn’t know what
she would do with her husband down.
He ran a fever
from the beginning. It got worse, every day a little worse. The antibiotics
could not contain the infection. I got a call one night and met her in the ICU
with the doctors. He died. The resident and one of the interns were privately
in a rage about the futility of the situation and feeling like somehow they had
failed. She was just flat when we came to talk to her. She knew why we were
coming together. We sat together for quite a while in silence. After a while, I
walked her outside in the humid night air. We stood there for a moment and I
asked her what she was going to do? “I don’t know” she said. And she turned and
In a weird way,
I liked University Hospital, mostly because everyone was there. In one
afternoon, I met a biology professor that wanted me to read the book of Mormon
with an open mind- and let me tell you that takes a very open mind- and visited
with the Outlaws, the motorcycle gang, because one of their girls had been
shot. Over and over in the midst of a religious conversation, I had to remind
them, you can’t smoke in the ICU hallway.
There are lots and lots and lots of
people in our country that live on limited incomes, have special needs, were
born with limited abilities. The ER in a major urban hospital is like jury
duty, you meet all of them there. In a strange way, I like that, because for
me, morally speaking, we all ought to have about the same access to health
That summer was
the beginning of the era in which we now live. That summer a health maintenance
organization, Humana, began buying up hospitals in Louisville. I believe there
were 9 hospitals and Humana bought up 6 of them. You may recall that
apocalyptic predictions were on the forefront of medical care in the early
80’s. Costs for fixed care were projected to grow at double-digit inflation,
the state born cost of covering indigent care expected to continue to grow to
the point that we were predicting fiscal insolvency for most of our hospitals.
Everywhere the cry was heard for controlling costs and this was the great
promise that management teams like Humana promised. With wholesale scope for
services and cutting unnecessary tests and procedures, health care premiums
would be held in check and affordable for the broad middle class in our
At the time I
was dubious about this approach and I continue to be dubious about it, though
it is clear that we have a serious issue on our hands. I am dubious because of
the original mission of our hospitals.
Up until the 80’s if you went to the
vast majority of the cities in our country, you could go to the University
hospital, the teaching hospital. Usually there was also a General Hospital,
often also the teaching hospital. Often there was a County regional hospital.
And almost all the rest were
religious. There was a Baptist Hospital, a Methodist
Hospital, a Catholic Hospital, a Jewish Hospital. That is because
health care was considered to be a mission outreach of the Church and Synagogue
and if we’d had more Muslims settle our country, it would be an outreach of the
had a mission of to heal out of spiritual convictions. Very often they took
their mission statement as a version of our gospel story this morning. A man
was sick and in need of healing. He couldn’t bring himself to the healer,
Jesus. So his friends carried him. The house was too crowded for him to get in,
so they opened the roof. They got him what he needed. And this was the way that
the administration of these hospitals ran. They had people in charge that were
medically trained but also a lot of people with a spiritual disposition. The
boards were comprised of good Catholics at the Catholic Hospital that thought
about what they were going to do and not going to do in light of what it meant
to be Catholic. And there were a number of Catholic volunteers in these
hospitals who were there because Jesus taught us that being a good neighbor
means binding up the wounds of those who are in need and that is what they
wanted to do. No question, these hospitals didn’t always live up to their
mission statements but they had a mission statement and that was
bought up these hospitals, they changed their policy towards indigent care.
Unless it was a life-threatening emergency, they stopped admitting patients who
didn’t have health insurance. Legally there was nothing to prevent them from
doing that. There was nothing illegal about it but there was something
profoundly immoral about it. Since they didn’t advertise it, we first noticed it at
University Hospital because there was a mild to substantial increase in our ER
traffic. University Hospital had no choice but to admit all patients. We were a
state hospital, not a private one. After a few months went by, University was
swamped with indigent care and we began hearing stories from our patients that
had been sent over to us in labor, with broken arms because they were uninsured
and not eligible for Medicaid.
incredulous. The whole system had worked in the past because each hospital bore
some of the indigent care and absorbed it into their overall operating budget.
The University Hospital always had most of the indigent care, but we didn’t have all of it. For many of the physicians, it seemed
tantamount to a gross violation of the Hippocratic Oath, which has a clear
pledge to work for the social health of the community, not just the wealthy
And for some of
us, it was an ugly reminder of a by-gone Jim Crow era when black folks in the
South were only admitted to colored hospitals. There were many tragic stories
from that era, like that of the great Jazz Singer Bessie Smith, who was on tour
with her band when they were involved in a terrible car accident. The white
hospital wouldn’t treat her for racial reasons. After a prolonged argument, she
died en route to the colored hospital on the other side of town. It is just not
After a few
months of this went on, University Hospital had a series of meetings because
they were projecting that they would go bankrupt in a matter of months if
nothing was done about the situation. Disaster was averted but a fundamental
shift had taken place. Medicine was no longer a community wide spiritual
mission. It was now simply a professional service that was offered on
contractual business terms. It was a small step over a cavernous crevice from
saying that medicine needed to reign in costs to deploying business managers to
run the hospitals like corporations. The poor remain an ethical obligation,
sure, but now the challenge is primarily understood as a legal liability rather than a mission. The difference is huge.
We remain in the
midst of those throes into the foreseeable future. A couple years ago, I got a call from a friend of mine, a
physician near retirement. He explained to me that his hospital recently got a
grant from a family to renovate a whole floor in the hospital for what we might
call Platinum service. Every room on this floor would be private, replete with
a number of amenities not presently available- internet access, some valet
services, a private Chef for the floor. The idea was to create a first class
hospital experience. There would be a charge on top of your normal insurance
payment that would come out of pocket. With the grant for renovation, the idea
was to keep the extra daily rate slightly above the price for a premium hotel.
Interest in the project was brisk.
He made an
observation that I have heard repeatedly from people in the medical field who
have been at the work for many years. We are rapidly moving towards a four
tiered system of health care in this country. First, there are those that can
afford to pay premium price, partly out of pocket. They have access to features
that are simply phenomenal.
Secondly, there are those that are
those that can afford the HMO benefits. In all ways, this group looks
increasingly like the harried economy travelers on a marginal airline --
cramped seats, booked full, maybe a bag of peanuts, circling the Newark Airport
for an extra hour and a half.
This group has to be advocates for
their health care, particularly if they have specific medical needs. I’ve heard
dozens of stories of Primary Care Physicians that refuse to refer kids with
allergies to an allergy specialist, for example. Patients feel like they have
to aggressively advocate their cause because Primary Care Physicians are
rewarded for limiting the number of referrals they make. I don’t know of
anyone, patient or physician, that likes being in an adversarial,Helvetica position. As
one writer for The New Republic put it months ago, any system that pits
the economic interest of the physician against the medical needs of the patient
is doomed to failure.
you are lucky enough to actually get the service you need, most of the time you
get a letter from your HMO listing a number of reasons that the care is not
covered under your plan. It usually is, but in order to get the proper payment,
you have to make half a dozen phone calls to the medical group back to the HMO.
It is a bureaucracy that is byzantine to the point that it makes you long for
the old Soviet Union. You can’t make this up.
And then there are the abject poor
that are covered under Medicaid. Their treatment is time intensive, inefficient,
- often below what people should have to endure. But it is available and the
costs are borne by the taxpayers. These folks swell the Emergency Rooms of our
teaching hospitals and are the first patients our medical interns and residents
get to treat- often outstanding care as a result of their care.
there is a class of people you might call the working poor. They do not qualify
for Medicaid and they can only afford medical insurance for a portion of their
life. It is not a perk for their jobs and budgeting for it requires them to
forfeit something else that is dear. A sizeable portion of this group cannot
rely on a steady income and thus periodically find themselves either uninsured
or underinsured. A prolonged or serious illness would devastate their fragile
economies. You know who these folks are. They clean your house. They cut your
grass. We buy fruit from them at the little grocery in Manhattan on the way to
the office. They push carts. They drive limos. They hawk tickets and ball caps
at Madison Square, etc., etc. Experts
who study this problem are worried that this group is growing too large.
not know what the answer to this problem is, though I spend an increasing
amount of my time thinking about it. And that is not the point this morning. We
have an issue on our hands that must be solved by this generation. In so many aspects
of our world, we tend to presume that if we simply allow the logic of the
market to run its course, a solution to our situation will eventually emerge
that will sort the whole situation out. In this case, it would seem to me that
the logic of our market forces is actually at odds with our spiritual and
humanitarian impulses. And therefore, the solution to the problem will be
complex and structural. I apologize, to you. I wish I could wrap this up neatly
with a bow and I can’t. I can only come back to our text which has a fresh
poignancy in our era. We have friends who are in need of healing. We are going
to have to carry them to where they need to go. And if need be, we may have to
dismantle the roof of the building and lower them down so that they can get the
healing touch that will make them whole. Amen.
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