Congregational / UCC in Iowa City               Sunday, July 26, 2015

Rev. Jeff Barton,  Iowa City Hospice

Consciousness and Conscience                     2 Samuel 11:1-15 & John 6:1-21 

 

I am at this pulpit this morning primarily because I want you and increasingly large numbers of our neighbors and friends to know more about hospice in general and your community, non-profit Iowa City Hospice program in particular.    That said, I also want to respect the responsibility and opportunity to bring – as best I can – a faithful proclamation of the good news that is the foundation of our shared Christian heritage and purpose.   

 

So if you are here this morning to ponder the sex and intrigue filled story of David and Bathsheba, I’ll probably disappoint you.  But I did hear a rumor that Bill Lovin might well return to this text with you in the next weeks.   For my priorities, however, it really isn’t germane that Uriah was facing the hospice eligible 6 months or less to live.    

 

The text from the Gospel of John is also not directly in my wheelhouse.  I pray that these two stories are familiar to you.  I trust that you will find a way to consider the encouragement they offer; both in the time of Jesus and his disciples and also in our time.  I doubt that it is as easy as merely connecting the dots between the feeding of the multitudes and the church kitchen remodeling that you have recently approved.  Still, such sketchy use of scripture is all too common within too many traditions that focus on scriptural authority more than on a deepening consciousness towards service of all humanity along with an increasingly sustainable conscience concerning our stewardship of all creation. 

 

I will suggest that the story of Jesus walking on the stormy sea does contain the crux of the matter today for me and maybe for you.  It is good news to remember that when we are confused and terrified – when we are concerned because of the rough seas that confront us in our health, in our well being and in the prospect of our very life and death – when we are confused and terrified the promise of our faith is that Jesus bids us, “do not be afraid.”

           

Hospice is a program, a collection of people organized to provide palliative care so that people with a medically probable life expectancy of six months or less might spend more time and energy enjoying their lives.  It is concerned with medical issues and also with emotional and spiritual quality of life realities.  Did you know that most people – and their families and/or caregivers – experience an increased life quality when they are allowed and encouraged to focus on what gives their lives meaning, and joy, and purpose, and comfort rather than when they are focused on how to postpone death? And the kicker is that hospice patients, in service for an extended period of weeks (rather than enrolled only during their final few hours or days) do tend to have not only a better quality of life; they also tend to live longer than those who pursue every available curative procedure.  

 

Think this through with me.  It takes a lot out of our strength, and soul, and spirit to undergo additional curative treatment when palliative (meaning comfort) care can allow us to marshal our strength for time with family and friends.  A holiday with grandchildren can be far better for our spirit than another round of chemotherapy.  A season of sharing grace with our loved ones and making peace with our circumstance can be much healthier than subjecting ourselves and our loved ones to problematic surgeries or experimental protocols.

 

The conversation about end of life care is not new.  Still, there are some important additions to that conversation in the popular culture.  The best seller “Being Mortal” by Atul Gwande,  and the PBS Frontline TV presentation of the same title, has been important in helping folks consider what will encourage a life more livable, most meaningful and joy filled. 

 

Further, over the past few years and again earlier this month on NPR, media have shared multiple reports pondering whether we talk enough about the options for palliative or hospice care.  The reports, sometimes with titles like “How Doctors Die”,  have all been tied to the fact that medical doctors are the most likely group of the society to choose palliative care rather than aggressive treatment when faced with the option of what to do when disease impacts the choices of those in their 60’s, 70’s and 80’s.  These reports all seem to be surprised that a unnecessarily large number of people die after or while being hooked up to life support in a hospital.  This is a fate physicians tend to avoid.   As Dr. Ken Murray wrote in 2011, “I fit with the vast majority of physicians that want to have a gentle death and don’t want extraordinary measures taken when they have no meaning.” 

 

I have been working with Iowa City Hospice for a little over two years now.  I work with the Spiritual Counselors (who I still revert and call chaplains) and with the Bereavement Counselors.  My background includes working directly for other hospices ever since I was part of a group that helped start a community supported, non-profit hospice in southeast Idaho in the mid 1980’s.  As a family member, I know that a hospice service made a wonderfully positive contribution to our well being when my father was diagnosed with and died from advanced colon cancer at age 60 in 1988.  As a local UCC pastor I have also been involved with hospice programs from New Hampshire to Oregon and from Montana to Arizona.  I mention that to assure you that as I say that I am most impressed by the staff, mission, community support and effectiveness of Iowa City Hospice – and I am – you will have some sense of my breadth of perspective.   There are other hospice options in this area,  but only Iowa City Hospice has a 30 plus year history of being the non-profit, care for anyone regardless of ability to pay, community supported hospice in Iowa City, in Johnson County, and in the six counties that adjoin Johnson County.   I also offer my thanks on behalf of the staff and board of Iowa City Hospice for your support --in time as volunteers and in treasured contributions -- in seasons past and in the future. 

 

Iowa City Hospice is a key resource for a program called Honoring Your Wishes.  This is a project which will encourage you and your loved ones to be clearly informed about what levels, if any, of aggressive care you would choose, and have that information shared at multiple levels so that your desires and your wishes are honored in the event of a medical emergency.   I have some handouts about Iowa City Hospice and about Honoring Your Wishes with me and will be happy to share them with you following the worship hour. 

 

There is an old preacher’s story about the revivalist who asked the assembled congregation for a show of hands to note, “who among them wants to go to heaven?”  Everyone in the church raised their hand, except for one young girl up near the front.  “Sweetie, don’t you want to go to heaven when your life is completed here on earth?”  “Oh, yes,” she replied. “Then why didn’t you raise your hand?”  The girl explained, “I was afraid you asked if I wanted to go now.”

 

Timing is important.  And even a willingness to enroll in a hospice program depends on timing.  Every Iowa City Hospice patient and situation is unique. Some have the progression of their illness stop getting worse, or even get better, and sometimes folks graduate from hospice care for a period of months or years.  More often people don’t even explore hospice until they have exhausted every aggressive treatment possible and – sometimes weakened by that course of treatment – have barely a very few days or even hours left to live.  We would hope that more of you would talk with your spouse, your children, your parents, and your family about what you would prefer to have happen should you be surprised by a traumatic illness or should you be diagnosed with a disease where your life expectancy is limited.  It is never too early to speak with Iowa City Hospice and you don’t need to be sick to explore Honoring Your Wishes. 

 

I believe it is true that a majority of contemporary seniors feel the same way that doctors do about wanting – when it is inevitable – to die at home, without pain, amidst the things that give them comfort and among the family and friends who give meaning to their lives.   But it is also true that most physicians have not been trained to talk to patients about death, and have been trained to fight disease at almost any cost.  Thus, when the options are given about what to do when COPD or cancer or another disease has progressed, too often the option of palliative or hospice care isn’t even mentioned.  It becomes important, for most of us, to not only know how doctors die, but what choices about other than aggressive (and often futile) curative treatment might be worth considering.  Be not afraid to have that conversation with your physician and with your family. 

 

Even though the disciples were rowing their boat, I wanted to share an illustration about sailing (especially since I sail a boat or two out at Lake Macbride.)  Consider that there was a small, but growing hole in the hull of a sailboat.  If the hole can’t be fixed, then repairing the sails, or replacing the halyards and sheets, or improving the electrical systems and running lights won’t really help keep the boat sailing for this season and the next.  I want to go further with this image,  and urge you to consider the idea that aggressive attempts of curative treatments might not be wise or desired when the combination of age and disease and circumstance all point towards palliative or hospice care being a better and a life affirming option.  That’s why doctors die at home more often than the rest of us. Alas, there isn’t time this morning to set sail on this illustration.  You’ll just have to settle for this small glimpse of the boat at its mooring.   

 

 

 

Ultimately, hospice is less about dying and more about making the best of one’s life to its conclusion. It is about having a clear conscience about the decisions we might prefer and about how our loved ones will know what we want to happen.  It is about being consciously aware of what matters to us, and consciously pro-active in helping others to enable us to live and die as close as possible to the way we desire.   Or as Iowa City Hospice affirms: “We may not add days to your life, but we can add life to your days.”

 

 

The disciples of Jesus were in the boat on the stormy Sea of Galilee, and they were terrified.  In the wind and the dark they didn’t know what to think or what to do.  So, the story tells us, Jesus comes walking on the water approaching near to their boat.  The disciples were not consciously aware of what they were seeing, and they did not have a clean conscience about what they might face if they were to die in those rough waves.  They were scared out of their wits.  So Jesus said to them, “It is I; do not be afraid.”

 

Friends, be not afraid.  Have a clear conscience in that in our faith story, nothing we have done or left undone can separate us from the love of God.  Have an open and aware consciousness to let your life be one of value and meaning and purpose that is centered on what you can do and be for others.  In your youth, in your early adulthood, and especially as our years and health concerns rise up like threatening waves in a stormy sea:  hear and believe the good news of Jesus, “Do not be afraid.” 

 

 

Sources and resources :

www.iowacityhospice.org

http://iowacityhospice.org/honoring-your-wishes/

http://www.npr.org/sections/health-shots/2015/07/06/413691959/knowing-how-doctors-die-can-change-end-of-life-discussions

http://atulgawande.com/book/being-mortal/

http://www.pbs.org/wgbh/pages/frontline/being-mortal/

http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/

http://www.nytimes.com/2013/11/20/your-money/how-doctors-die.html

http://www.fredhutch.org/en/news/center-news/2014/05/How-doctors-die.html