Transforming Care: A Christian Vision of Nursing Practice (13 page)

KARL BARTH

Paradoxically, there are even cases when the diagnosis of a physical
disease can actually be the stimulus for a person to lead a healthier life.
When a middle-aged man receives a diagnosis of heart disease, the realization that he could die sooner than anticipated can prompt him to move toward
health in many dimensions in his life, including the physical dimensions. He may
examine the meaning of his life, his relationships, and his habits, and he may reorder his priorities in ways that lead to
greater health. He may change his eating
habits so that he consumes fewer calories and less fat, and he may come to
consider mealtime as a time when relationships with family and friends can be strengthened. He may think about ways to exercise more, whether
that means going to a health club regularly or choosing to climb stairs instead of using the elevator. He may determine that his life has more meaning and satisfaction when he serves the needs of others rather than pursuing career success exclusively, and he may choose to find the time to help
second graders at his daughter's school learn to read. He may think about
the possibility of his own death and thereby seek to strengthen his spiritual
life. If this man is a Christian, the sudden awareness of his own finitude
may make him rely upon the peace and strength of Christ in ways that he
never knew were possible. Six months or a year after his initial diagnosis
with heart disease, he may see that he understands his humanity more
fully and is healthier than before the diagnosis of physical disease. To call
him healthier, however, is to evaluate his life along one particular axis, that
of his awareness of and responsibility for central aspects of his life. If we
are speaking specifically of his physical state of health, we still need to recognize that he lacks a crucial part of physical health.

This alerts us to the fact that health is always evaluated in relation to
background assumptions about context and social situation. We evaluate a
95-year-old woman who walks two miles a day as healthy because many
95-year-old individuals are significantly less mobile. A physically able i8-
year-old, however, will hardly be evaluated as healthy merely because she is
capable of a two-mile stroll. Any time we use a term such as health we assume a set of conditions that serve as our standard of normal health, and
as those background assumptions change, so does our assessment of
health. This is an important component of nursing practice, since it reminds us that when we speak of health or wellness (or illness, pain, or suffering) we need to be clear what aspects of an individual's life are being
evaluated, against what standards, and the like.

Further, although we can acknowledge that good may come in the midst
of pain, that health may grow in the midst of disease, this acknowledgment
should not eclipse from our view the very real suffering that accompanies
disease. Others in the room may feel less awkward because Rita bravely
smiles in spite of her pain, but if Rita feels that she must produce such a
smile, something in the situation could be quite wrong. Sometimes people
do deal better with suffering when they are able to focus on others and generate a certain level of stoic acceptance of physical pain. We should recognize
that different people use different methods to deal with crises. But we should
be careful not to expect every Christian to show a brave face, to smile in the midst of suffering, to deny the lamentable condition in which she finds herself, or to worry about whether others feel awkward to be in the presence of
her suffering. Here is a place where a Christian nurse could gently attend to
this client's spiritual needs by assuring Rita that she does not need to concern
herself with putting others at ease. She does not need to deny her pain or
pretend that all is well. Her body is not functioning as it was designed to. She
can lean on the strength of others in this time of weakness.

In the midst of this painful experience, Rita has the opportunity to
confront her own finitude and to ask what constitutes a beautiful and
meaningful life. The nurses in the Emergency Department may not have
the time or resources to engage Rita in asking these questions, but there is
another who may fill this role. As a nurse who is comfortable enough with
Rita to ask about her grandnieces and to know about what she needs in the
bathtub, James surely knows Rita well enough to engage her in conversation about the meaning of her suffering. He may refer her to a pastor or
counselor, but he may also be available simply to listen when she needs to
talk. Christian nurses, in other words, need not shield their clients from
asking tough questions or from the difficulty of seeking answers. In Chapter One we noted that the Christian nurse should not see his or her spiritual role as one of trying to make sure every client has a conversion experience. But we most surely do not want to rule out the Christian nurse's
responsibility to be aware of spiritual suffering in a client, to ask if the client needs to talk about struggles and questions, and to offer to be a Christian presence in the client's life when that is appropriate. This is good nursing, and it is part of the nurse's professional responsibility to be concerned
with the holistic aspects of the health of the client.

We have noted that human life involves a process through which we
strive toward health and shalom, seek our place in God's world, and recognize our limitations and dependence. But what does it mean for individuals to recognize their place in God's world, and how is this tied to health?
We acknowledge that God is Creator, Sustainer, and Redeemer and that the
purpose of life is joyful service to God. This context is what gives health its
meaning. We rob health of its meaning when we fail to recognize that it is
only a means, an instrument, by which we can joyfully serve God. Health is
not an ultimate good. Margaret Mohrmann, a reflective Christian and a
pediatrician, suggests that our society tends to idolize both health and life
as ends in themselves, thereby denying the real source from which health
and life derive their meaning and import. She writes of this idolatry:

Reinhold Niebuhr has said that evil in its most developed form is always a good pretending or imagining itself to be better than it is. The
idolatry of health is a good example of this process, of pretending or
imagining that the relative, subordinate good of health is better than
God intends it to be. Evidence of the idolatry of health in our society is
clear, manifesting itself in our fickle, shifting obsessions with diets and
exercise machines and with jogging down every primrose path to
perfect health, whether it is the path of vitamin C or brewer's yeast or
no yeast at all or oat bran or whatever the latest "cure du jour."
(Mohrmann 1995, 14)

Mohrmann goes on to critique our society's obsession with health, especially in our over-valuation of a healthy, youthful body. This obsession reveals that we do not really understand the true, multidimensional nature
of health or humanity. She notes that even when we focus on establishing
and maintaining good mental health, we often do so because it will contribute to better physical health. "We try to be calm so we can avoid ulcers
and heart attacks," she argues, and "we try to think positive thoughts so
our immune systems will be stimulated to do their jobs more enthusiastically. A true and complete understanding of health includes mental and
spiritual health as important ingredients in their own right, not just as
promoters of physical health" (Mohrmann 1995, 15).

Understanding health as an instrument that allows us to live joyful,
complete lives of service to God allows us to put the good of health in its
proper relationship to the other good things in human lives. It also helps
us to find some peace when wrestling with issues of health and disability,
aging, and dying. We acknowledge that we live in a fallen world and that
this fallen nature keeps us from attaining perfect health. Yet striving toward health means that we find ways to cure and accommodate where possible, as well as to accept our limitations where accommodation is not possible. Henrik Blum writes, "Health is the state of being in which an
individual does the best with the capacities he has, and acts in ways that
maximize his capacities" (Blum 1983, 93). Christians with diminished
physical and mental capacities, whether due to disability or to aging, can
strive toward health when finding ways to live joyfully and to serve God
with the capacities they have.

We cannot speak about health without also addressing issues of disability. Disabilities of one sort or another are so common as to be almost universal. Some people have chronic dry skin, others are lactose intolerant,
others have the far-sightedness that often accompanies aging. These disabilities are relatively easy to cope with. One can use lotions, avoid milk or
add the missing enzyme to the diet, or wear glasses. Other disabilities interfere more significantly with the ability to perform important functions
or require social intervention in order for the individual to flourish. Some
theorists limit the definition of disability to conditions that fall under one
or the other of these categories, in fact, so that the conditions mentioned
earlier would not even count as disabilities (Bouma et al. 1989, 56). Because
health is multifaceted, we can recognize that those with a disability in one
physical or mental dimension can nonetheless experience health in other
physical or mental dimensions, as well as in the social and spiritual dimensions of their lives. The recognition that health is not a single value and
that it must be evaluated against a background of assumptions about context and social settings allows us to celebrate whatever aspects of health are
possible in an individual's life, without losing sight of the difficulties the
lack of health in other areas may create.

At the same time, the holistic sense of the human person that is at
work in nursing allows us to be aware of the ways in which diminished
health in one area of life can also have a serious impact on other parts of an
individual's life. As George Agich writes, "When the illness and symptoms
are severe, the orientation to the world of everyday life, if not loosened, is
altered in various ways and so the energies of the self are understandably
directed away from routine activities and toward the general task of constituting new structures of meaning" (Agich 1996, 146). Part of a healthy response to disability or chronic illness is a redirection of energies, a reordering of life in general so that necessary adjustments can be made to the
ongoing changes in one's life. It is important for nurses, who generally experience relatively good health, to be aware of the many ways in which a
chronic illness or disability may require turning away from normal aspects
of life. In many ways Rita is an easy client to deal with because she is cheerful and self-motivated. This makes it easy to recognize the healthy aspects
of her life. A client dealing with chronic and debilitating arthritis pain,
however, may not always be cheerful, and her admission of pain and planning ahead to avoid overexertion may be just as healthy a response to the
conditions of her life as are Rita's cheerfulness and activity.

It is also important, when thinking about health, to recognize the extent to which health is not simply a matter of an individual's condition. It is often the conjunction of a condition with the presence or absence of various social goods that determine whether someone is disabled or not. Our
society sometimes responds in positive ways to help individuals flourish in
spite of disabilities: providing Braille lettering on doors and elevators, curb
cut-outs on sidewalks for wheelchair access, voice-recognition software for
word processing, and even playground equipment like swings with specially shaped seats and straps that allow physically disabled individuals to
enjoy the thrill of having the wind blow through their hair. It is important
for society to continue to use and find new technological, social, and pharmaceutical interventions that allow people to flourish even when they have
limited functions of various sorts. The holistic account of health that nursing has adopted is an important reminder that health is not simply a matter of an individual's condition but is also a communal issue. As we noted
when we spoke about the nature of persons in Chapter Two, persons are
fundamentally interdependent, and we see what this means when we think
about health.

Our society sometimes tends to fall into an idolatry of health. This
idolatry is evident when we fail to respect those with disabilities, or when
we act as if lives that involve disabilities are lives that are not worth living
or not worth investing health care dollars in. We can fail to recognize that
physical disabilities are compatible with full decision-making capacities
and treat an adult with quadriplegia as if she were a small child. The idolatry of health can also indicate a fear of death and a denial of death's inevitability, both of which indicate a lack of hope. Our society tends to seek
salvation through medical intervention, and in the context of health care
we frequently encounter language that suggests that the avoidance of death
might be possible. Evidence abounds: hospital advertisements on billboards read, "Saving Lives Every Day," and "Partners in Saving Lives." But
only God can save, and health care workers who try are doomed to failure.
Life and health are given to us by God so that we can live joyful lives of service in community, and as long as we seek health and life for that end, we
seek them rightly (Mohrmann 1995, 20). Within that context it is possible
to pursue health without making it an idol.

The pursuit of health, even when it is properly contextualized by
Christian values, can never be completely successful because human lives
always come to an end at some point, because accidents happen, and because diseases and suffering are part of the human condition. When we
discussed the nature of persons earlier, we noted that embodiment implies vulnerability, and we return to this point when we think about health. We
care so much about health because we know we are always vulnerable to
the loss of some aspect of health. In spite of the best efforts of nurses and
other health care workers, individuals with disabilities will struggle with
the difficulties they face, people will die, individuals will suffer painful diseases, and babies will be born with dreadful genetic disorders. Nurses
know better than almost anyone the depth of sadness and tragedy caused
by the lack of health in our world and our need for lament in the face of
that sadness. But lament is not despair. We know what health is because we
see the marks of a loving Creator in the health of those around us, and we
hope for the eventual restoration of all of creation by a God whose love is
never failing. There is a "double vision" quality to the notion of shalom. It
allows us to see what is not yet, while at the same time we see what we are
called to at this time.