“Foot Care”

Once I was visiting the oldest member of my church.  “How are you?” I asked.

“I’m doing OK,” she said, “but I just get so frustrated that I can’t do the things I used to.”

“Dora,” I replied, “you’re 105 years old!” The fact that she was able to wake up in the morning, recognize me and carry on a lively conversation was nothing short of remarkable at her age.

Atul Gawande

Atul Gawande’s book Being Mortal is a reflection on what it means that we are creatures who, over time, age and eventually die. Human existence means learning to live within the limits of our mortality.

Gawande writes from the perspective of a surgeon. Modern medicine, he says, operates out of a paradigm centred on diagnosing and curing disease, and fixing what is broken. But what about when people can’t be fixed? What about when the problem is not a specific pathology but simply the limitations of being mortal which become more pronounced with age?

The tendency of the medical system is to a) continue to try to fix what’s wrong, often inflicting needless suffering on the patient, or b) simply give up. Care of the elderly eats up huge resources, but often with little positive results.

Gawande says the question needs to change from “How can we fix what’s wrong with this patient?” to “What is the best and fullest life possible for this person, given his or her limitations?”

I think there’s an analogy here for many of our churches. (Recognizing that any analogy can only be pushed so far. There are similarities between an individual and a community, but there are also differences.)

A lot of churches, like a lot of church members, are struggling with diminishing capabilities. They are not what they once were. They can’t do what they once did. Partly that’s the result of changes in our culture, which has pushed religious institutions out of the centre and onto the (almost invisible) margins.

The leadership in many United Churches are people whose concept of a vital and healthy congregation was formed in the 1950s and 1960s.

Even though they know things have changed, their attitudes and actions are still driven by powerful memories which shape their image of a healthy church.  Compared to that memory, the present reality of the church can only seem like a failure, a shadow of what once was.

The problem is that a lot of energy goes into ultimately futile strategies to try to “fix” what is wrong – to get the young families back, to change the music, to start this or that program. All of this can distract us from engaging deeply with the basic question: “Given the reality of where we are, what does a full, abundant life in Christ look like?”

The fact is that most United Churches will have a high percentage of older people. To change that significantly would really mean that the present church would need to cease to exist and something entirely different take its place.  So, the question is, “How can we be faithful and fruitful as who we are?”

Atul Gawande writes of shadowing a geriatrician as he treats his elderly patients. Ironically, in an aging society, gerontology is a dying specialty, with low in status and relatively low in pay. Few medical students are interested in specializing in the care of the elderly.

But geriatricians can make an enormous difference to people’s lives, often through paying attention to very simple things. Gawande watched as the doctor examined a woman in her 80s who had no specific medical condition. Her main problem was that she was old.

Gawande noted how much attention he paid to his patient’s feet.

That’s because one of the main threats to the well being of the elderly is falls, and one of the top three causes of falls is improperly cared for feet.  Simple, modest, low tech.  But crucially important.

I wonder:  What would the church equivalent of “foot care” be? What are the simple things we could be doing to prevent “falls” in our churches – those preventable crises that can fracture an already fragile congregation, incapacitating it and perhaps hastening its death?

We may not be able to “fix” everything in the sense of recreating the kind of robust strength of people’s memories. But what steps can we take to stabilize congregations so that they can continue living well.

Another key ingredient in the care of the elderly, Gawande discovered, is a reason for living. Boredom and depression are two of the great robbers of vitality. Helping people discover a reason to get up in the morning is enormously important to their well being.

It’s what, in the church, we call a mission. Many congregations are abandoning any sense of real mission because they believe they are too small, too old, too tired to do anything useful. But that’s because their mental image of being in mission implies strenuous physical activity or traveling to a different part of the world. Jesus calls every Christian to a mission and I don’t think Jesus intended to abandon us when we get to a certain age.

The real problem is that if nostalgia, loss and low congregational self esteem dominate, we become unable to discern the possibilities of the here and now.

I am not suggesting that all we should do is palliative care, “keep the patient comfortable” until the end. That is one of the differences between an individual and a community. A community is not limited by the life span of any one individual. Communities can regenerate and be reborn.

But, Atul Gawande advocates shifting the focus of medical care from simply fixing and curing to helping people determine what is most important and taking simple measures to minimize threats, enhance possibilities and instil a reason for living. Studies have shown that when these things happen, even the frailest of the elderly can experience a profound transformation in the quality and meaning of their lives.

As Christians, we believe in a God who raises the dead. We believe that real transformation is not our achievement, but a gift of divine grace. Our role is often to remove the barriers that prevent us from experiencing that transformation.

Perhaps if we became more focused on helping congregations determine what a rich, full life in Christ means, given the limitations of their situations, we might find that change happens in exciting ways we never expected.