Boundary Leaders – garygunderson Blog

Potbound

Sometimes a houseplant will get too large for its clay pot. You don’t notice at first but it slows its growth as the roots circle sideways around and around in a futile strangle. Even in a new a new pot the roots will keep circling and hardly notice the new soil. Not really dead; a withered version of itself that lost the plot.

I’m talking about hospitals here, most of which were created a hundred years ago by faith and community groups who saw that the simple science of their time could benefit their communities by providing healing and justice at large scale. Hospitals were uncomplicated enough for church committees by the dozens to consider starting one with donations, led by pastors and nuns, linens sewn by congregations. Today, these roots circle inside massive brick pots, out-scaling every other local non-profit organization by a quantum; way beyond the capacities of pastors and nuns to keep them on task.

Non profit hospitals are supposed to be kept on mission by a legal tool called “community benefit,” which works about as well as a fig leaf in the Arctic. The idea of “benefit” dates from when “mission” meant giving away urgent care instead of the goal of community-scale well-being that health and social science now make possible. A recent report from the National Academies of Sciences makes the missed opportunity painfully clear (National Academies of Sciences, Engineering, and Medicine. 2023. Population Health Funding and Accountability to Community: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27258).

Kimberly DiGioia, a program officer at the Patient-Centered Outcomes Research Institute, provided an overview of findings from her research on the effects of Medicaid expansion on community benefit (DiGioia, 2022). About two-thirds of hospitals in the U.S. are nonprofits, spending between 8 and 9 percent of their total operating expenses on community benefits, which seems impressive. But she explained that the vast majority of community benefit spending goes toward charity care, and unreimbursed Medicaid services while a small amount of this money goes to community health improvements. This includes educating its own health professionals, subsidized health services, medical research, and smallest portion, cash and in-kind contributions to community organizations.

The passage of the Affordable Care Act, DiGioia said, raised optimism that hospitals would report more revenue and less uncompensated care and thus spend more on community health. Indeed, the evidence has shown that the more Americans are covered, the more hospitals reported increased Medicaid discharges and decreased uninsured discharges. There was indeed a decline in uncompensated care, but this was offset by an increase in unreimbursed costs associated with caring for Medicaid patients. They charged more for less care and as a result, “community health improvement spending did not increase as expected.”

Pot bound.

Instead of growing into the rich soil of community health science, health system roots just circled the pot. This is a failure of hospital governance and timid government policy, not lack of science or administrative skill. Boards never fire a CEO for bad community health; the government settles for health fairs and a mobile van.

Thousands of highly skilled administrators and staff came to the profession expecting to grow like an oak in deep soil (they don’t mention the pot in school). These are honorable people trapped in doing small things. At a recent medical school reception honoring TC and I, Dough Easterling reminded us of when we traveled across the country in a Winnebago testing the idea that “everything we hope for is already happening.” He quoted us back to ourselves:

“We traveled with the sharp awareness that we are among the privileged class, linked to institutions among the most privileged of all—academic medical centers. It is striking how little is asked of these vast organizations. In most every community the healthcare organizations are pretty much busy with running the hospital. The staff might be kind in the ER and diligent on its wards, but not likely to cross the sidewalk in solidarity with the poor and suffering. There are exceptions in every hospital, but as institutions, the expectations remain low for a reason.” (Road Trip, Stakeholder Health, 2019)

Jim, TC and me in Wilmington NC —our 29th stop 2,600 miles after leaving San Diego. Everything we hope for is happening, but often trapped in small pots.

There are three ways to approach this withering, this tragic failure to fulfill our missional DNA.

One is to ramp up community benefit regulations. Not many hospitals have the internal capacity to know how to do that kind of work, so give local public health authorities power to get intimately involved in deploying hospital funds into serious programs of prevention, social determinants and chronic condition management. Don’t count “loss” on Medicaid and Medicare or training their own medical providers. The political screaming will be deafening as the ones that own the pots resist.

Two is to simply let non-profit hospitals remain inside their acute therapy pot, but give up the pretense that their efforts have much to do with community. Treat them like banks with some, but minimal, expectations of community good. Banks have to invest actual cash in the communities they previously damaged by redlining. Hospitals should do the same in the same communities as well as providing decent access for urgent services.

Third, create a special legal category for mission-driven hospitals. The 21^st century work of advancing health at community scale needs a whole new pot. These hospitals would be like Community Health Centers (FQHC’s) that get preferential reimbursement for services that make them sustainable once they are built. Hospitals would need what they once had—preferential and protected access to borrowed capital so they could have modern technology. Treat them like missional utilities with no advertising permitted and community people on their governance Boards. True accountability is needed for meaningful integration with public health and social services, both governmental, private and faith. Restricted pay disparity between highest and lowest staff. Built for mission.

The National Academies report notes that Community Health centers offer much of this logic, but built for primary care, not acute hospital services. But why not? Every one of the major hospital systems have some hospitals they don’t actually want, that won’t ever make much money. Why not flip them to this different model?

We could do so much more with what we have. But our communities have almost given up:

Contrasted with the high enthusiasm when the hospitals were created, “the low expectations of (of hospitals) were striking—maybe for more health fairs, slightly kinder financial assistance policies, or free parking for clergy. We didn’t hear any calls for transformation, hardly any for solidarity. Yet those of us inside the institutions know how much more might be possible.” (Road Trip: Soundings. USA: Stakeholder Press, 2019).

We’ve been circling the pot. We need to break it, point the roots to deep soil and get to work.

Lost bee, found bee

That’s me on the upper right trying figure out how to talk to the guard bee at the entrance.

Forty thousand honeybees live above my parked car, which is often cluttered with beekeeping accoutrement that smells of wax and honey. It is common for a few bees to tag along for the ride. Beyond two or three miles and they can’t find home so they will circle a bit, tasting the air for a waft of nectar, resin, honey from a hive nearby. They can sense a hive vibrating with life that might welcome a lost bee laden with honey or pollen from the back of my car. Honeybees are a practical lot, unlike wasps that tend to chew up visitors.

A honeybee shares a mother with thousands of sisters with a random assortment of absentee sperm accumulated on mom’s one big day on the town. A bee is so fully integrated into the superlife of the three-pound hive that a solitary bee can hardly be thought to be imagined unless they accidentally drive away in a car. The bee has a tiny brain devoted to life and death issues such as where the nectar is, what the hive box looks like and her immediate job at hand. No brain synapses to waste on lingering affections, so in about three days she will not remember her sisters. The new sister will learn to dance among thousands of new kin until her her wings wear out in a month.

A worker bee lives about eight weeks collecting a twelfth of a teaspoon of honey. You and I live 4,750 weeks often, without producing anything as helpful. Humans exaggerate what can be done in a season, while cynical about longer transformations. Impatient foundations often force recipients to promise transformation in three years while cynically avoiding commitment to the city-sized transformations that could be realized in a half generation. Ask any bee.

I found myself thinking about these issues when I noticed that a bee was riding with me on the four-mile drive from the hospital where I used to work to my new home on the Wake Forest University. This was my hive once—I can see my freshman door room out my office window. And while academic guard bees notice my hospital scent, I do carry the equivalent of pollen for the young ones (a new course on Leading Causes of Life). And friends from South Africa, Germany, Texas, California and even Finland with sweet nectar (ideas) that might help the hive. Here’s a link to the Baobab conference we just hosted. I’m already forgetting the old ways.

Bees don’t try to teach humans anything, given our short and unpromising evolution. But they allow us to observe and notice their practical balance between intense selflessness and short term memory. We humans exaggerate our individualism, thinking that the skin-bag holding our squishy parts and three-pound brain is a functional whole. And, opposite of bees, we nurture unhelpful affiliations long after they are are relevant to our future. A bee forgets in three days; about five years for humans. This may be a bit quick for our species.

Bees are a bit ruthless in their commitment to the future, but we should also focus on the neighborhood in which we now live and the people with whom we might thrive. I’m thinking of the tortured shore east of the Mediterranean. The sad futility of my dad’s old political party. The pathetic rending of old religious groups voting about other people’s sex. Hospital systems tethered to old therapeutic techniques instead of modern population health science. Seminaries teaching the same stuff they did 180 years ago. Universities organized the way they were when I was a freshman; for that matter, when my father was a freshman and his dad, too.

(Don’t mention these last two to my new guard bees; winter is coming and I need a hive.)

Social, now

The top floor of Baylor Scott and White hospital is dark wood, deep carpet and lots of glass, out of which one can see Dallas stretching to the dusty horizon. A physician noted that the people visible to the southeast near the Ferris wheel tend to die about 12 years sooner than those on the other side the same distance from the hospital. This is why I was there talking about the “social determinants” of health and what religion has to do with them. You’ll notice the phrase has two problems, “social” (when it really means “non-medical”) and, worse, “determinants” (when it really means variables). Hospital leaders hear about these factors a lot these days, but nearly all the problem and possibilities called social lie on the other side of the sidewalk outside their control.

The school is way more important than the hospital. Two scholars (Case and Deaton) sifted life expectancy data to clarify that people who don’t graduate from college tended to die 8 years younger. It’s not because the books would have taught them health-related tips. College is a social marker, mainly about one’s parents social position which is a big boost toward the student’s. Hospitals are pouring money into new IT to see what social determinant things such as food and short-term housing that their patients need. That is nice but misses the point. And it misses where to work.

It may surprise the well-educated, but not those on the downside of the data. The two thirds of Americans who did not go to college know all about early death; no wonder they are angry and vote with fury.

Social is the thing that happens when people talk to each other. In this case, at Tova Coffee House in Lubbock, TX

In 2008 the World Health Organization commissioned a global study on these poorly named factors, led by Dr. Marmot, who was famous for noticing that life expectancy decreased in a step-wise factor with each click down in social position within bureaucracy. The 2008 report said sharply that “social determinants can be more important than health care or lifestyle choices in influencing health.…studies suggest that SDH account for between 30-55% of health outcomes. ….the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.” We’ve wanted to blame the doctors and the hospitals when the problem falls on all the rest of us.

The critical role of social drivers has two inconvenient implications for hospitals and one for people of faith. Hospitals have been happy with the assumption that they are the key to extending the health to everybody who can see their large buildings. Modern healthcare is mind-numbingly expensive. The business model draws from a deep well of borrowed money from nervous bankers requiring vast reserves to ensure they are paid back. The weird irony is that hospitals look like they have a lot of money, but it is reserved for the banks, not the neighborhoods. Everybody hates this.

Hospitals are legally obligated to provide “community benefit” but nearly all of it pays for expensive free care offered inside their tall buildings. Some count medical education (of doctors, not the patients). In some states they count the loss between what government pays for Medicare and Medicaid and the actual cost. Less than a nickel of every community benefit dollar goes to anything in community. Everyone involved hates that, too.

We should release the hospitals from the unrealistic expectation they can do what they’re not designed to do. They deserve tax benefit for giving so much care to people who can’t pay. We don’t want citizens dying, writhing on the streets. But—and this is the inconvenient part—we should no longer pretend that hospitals can solve what all the rest of us need to be accountable for. If hospitals can’t do it, they shouldn’t get political credit for pretending to try. Let the money follow the science to where health is created: especially the schools, social supports and public health that advances the health of everybody.

The day after speaking in Dallas, I was on a Stakeholder Health Zoom, a sophisticated group that knows all about this cruel reality. We we talked about how to get the money and attention out the door and into the streets. One promising clue is the rapid spread of communities using the Vital Conditions and the Thriving Together document to approach the radical complexity of assets in community. This has already sparked an extraordinary 53-agency Federal Working Group to advance health for “all people, no exceptions” at that level. We just have to do the same at the local level.

As I was preparing for the Dallas lectures, I came across a note that President Carter sent me when I was leaving his Center to go over to Emory University. He was not impressed. And he would not be any more impressed with my recent move to Wake Forest University Div School.

He hates needless theory when there is something practical to do. And he hates pretending that someone else should do what we can do any Saturday. Science says that health comes from people being in the right relationship to each other. It always has.

That the power of the social.

TGP

There are two reasons for grown-ups to avoid church. First, they’ve never been. My grandson once asked me with innocent curiosity what that building is with the “t” on top. Many others have been and see no reason to come back. The experience may have been repellent, demeaning or embarrassing. When you hear the worst people in public life explain their ugliness with faith, sensible people back away and keep the kids out of earshot. But it is far more likely that the church was inoffensive– less interesting than another cup of coffee, a walk around the block, tennis or whatever.

By Zach Stewart ( (a heck of a TGP) originally drawn for the Barefoot Guide book on Generative Leadership.

I’m speaking of church, but I’m guessing something happens like this in other religions, too.

I have found my closest working partners in two groups. The first are inside the church, but near the back door ready to get back on the streets. The second are already on the streets surprised to find themselves friends with a religious guy like me. We share the energy, joy and pathos—but not “god-talk.”

Next week twenty authors from Africa, Europe and the United States will gather at Wake Forest to blend our thinking on a book on religion and health to be published next year by Elgar Press. The intellectual sausage is still in process, so it’s premature to share detail. I mention it because most of the authors are in the two groups—some surprised to be invited to anything religious and all surprised by the creative energy released.

I am trying out the name “theogenerative practioner” for those propelled by an experience that feels ultimate and urgent, not just dutiful or godly. TGP for short. They are everywhere which is why I can’t despair. When Stakeholder Health gave Soma Saha and Ji Im our Jerry Winslow and Ruth Temple Bell Award in June, I called all of them that. Legendary practice; the theo signals the well from whence comes the imagination and resilience.

Writing in a more academic manner about “theogenerative practice” for the book I had to deal with “theo.” Jim Cochrane pointed me to Rev. Dr. Ted Jennings, our late friend from Chicago Theological Seminary, a TGP who wrote a wildly generative book, Beyond Theism, in 1985 (out of print, but available used on Alibris). He said we had been suckered into defending an abstraction called God—and the dangerous claptrap of theism. We misplaced the real mystery, that we humans experience God more like a verb than a noun. Ted did not care about God as an abstract ultimate cause that lends itself to authoritarianism. The abstract god justifies structures of religion, culture, politics and practice whose inertia robs the poor of hope for change and, risks the extinction of us all. A Christian theologian, he cared less about God as creator and more about the liberating Spirit. And he cared about the itinerant carpenter who was killed by the twisted authorities of religion and empire for proclaiming justice and mercy. Count me, in Ted.

Although TGP’s are often not religious, we find “god-talk” helpful as we talk to each other about the experiences of being drawn, called, called out, confronted by the deeper currents of life. Ted was careful to note that a lot of non-religious people experience this even when they don’t have “god-talk” to explain it: activists, artists, care-givers and healers. Maybe you and me.

I think of Brooks Hays, Jimmy Carter, Bill Foege, Jim Curran, Howard Koh. And John Lewis, of course, who became an icon of generative public justice-making. He was raised in the church; long called him “preacher” for his earnest way of preaching to the chickens under his care. (Read Walking in the Wind right away!). But his life changed when,

“on a Sunday morning in early 1955, I was listening to our radio…as always, when on the air came a sermon by a voice I’d never heard before, a young minister from Atlanta…. But even more than the voice, it was his message that sat me bolt upright with amazement….This was the first time I had ever heard something I would soon learn was called the social gospel….I felt that this man—his name was Martin Luther King Jr.—was speaking directly to me.” (Lewis, p. 56).

He was transformed forever; following, following, following and in then leading, leading and leading. This was an event that opened the possibility that oppressive political realities could be disrupted, too.

We may never have another John Lewis or Jimmy Carter. But we may never have another you or me, either. It is entirely normal to have one’s life disrupted by events and inbreakings that release us for what we are made to be, made to do. Ted would say the work of theology begins with these events, not the old dry abstractions of theism. God is not done. What?!?!?!

Don’t skip over “generative.” This is the quality we recognize in God and the people. And not just practice which is nice, kind or proper. This is what makes God disruptive and impossible to tame by human systems. And this is why generative theologians scare defenders of the old ways.

A critical role for TGP’s who are religious like me is to defend theogenerativity against authoritarian religion in the public square. We needed this in COVID when religion was used to undermine public health. And, sadly, we see it in the most ironic place—love and the wonders of sexuality. Amid so much hurtful blather, we have to say clearly that God delights in generative relationships; you can’t have too much love across the whole fluid alphabet of sexual identities. God loves love.

By Jimmy Carter. Hanging in the Zaban Room of The Carter Center

We need tens of thousands of theogenerative practioners. And I think we have them. We have twenty-five new ones starting at our School of Divinity. Jerry Winslow is still disruptively typing at 78. I promise you that Jimmy is doing something theogenerative on his 99^th birthday.

Why not you and me?

Love finds a way

Celeste Wray a spirit warrior who belonged to St. John’s United Methodist church in Memphis, Tennessee which has seen its share of evil and evil overcome. She fought every good fight with grace.

On Memorial day we often think of those who gave everything so that others could enjoy the normal pleasures of human life, especially the love of family. It has also become a day when loveless political bullies bluster at some already-stigmatized set of people unlikely to hit back. Their cowardly ugliness hardens our social spaces and hurts people who have already been hurt by their families. It continues partly because they rarely go after groups that can’t easily hit back. They don’t attack older white heterosexual married hospital executives. Or ordained Baptist ministers. Like me. I recently presided at the wedding of two kind women whose hearts had found each other. Why would they be attacked and not me? Because bullies are weak, the kind of people the heroes of memorial day faced down.

I wore the robe and read from the Bible my mother gave me upon my ordination:

“You can see, feel and hear that the whole universe sings, hums, buzzes and claps its hands on this happy day. We signed the North Carolina State marriage license before the ceremony to get the government out of our family affairs. So why do a marriage ceremony at all? The State permits love, but only a sacred event with family and friends cements it.

“We know that some in our hard-hearted world think that these two lovers should not even hold hands, much less be joined in matrimony. So it is important that we support their love for each other from this time forward.

“These two wise and thoughtful women considered their decision carefully; they do not need any wisdom from me about how to live their lives or give themselves faithfully to each other and the world. We can see they know this.

“It important for an ordained minister of the Gospel of Jesus Christ to grant sacred blessing to carefully considered committed love. There are those who would not; those who fear the overflowing love of a wildly abundant God. But if we did not celebrate this love as holy, true and sacred, the rocks, trees and earth would cry out and sing instead. This love and this marriage is of a loving God who has made us to have love and then make commitments and keep them so that love matures over decades as a gift for each other and for each of us who are also blessed by their love.

Reverend Mark Stephenson is the South African Methodist minister who presided over the marriage of TC and me.

Anyone could see their natural kind way in the world. They grow things, repair things, clean things, bring stuff into order. They give themselves in labor and skill. They are thrifty, kind and wise; and better at everything because of their union. This is obviously a union made by God, even if some of the family was still getting used to the idea.

I pronounced them married. What God made One, let nobody and nothing separate, especially some loveless bully who wouldn’t know love if it walked up and kissed them on the lips.

We did the wedding in the backyard of our home shared with six hives of mostly girl bees– 150,000 sisters who provided the mead with which we celebrated over dinner

We need lots of love.

TC and me in the Monadnock Room (overlooking the mountain) the day before the wedding. The actual day was marked by heavy rains which are acknowledge in most cultures as a sign of great blessing.

Last weekend TC and I were in New Hampshire to dance at another wedding. Like most love, it was improbable and inevitable. This woman and man had been so bruised by earlier marriages that they had given up on love entirely. It fell to their children to encourage them to try again. And love found a way! The wedding ceremony lasted at least three hours with all that Irish, Indian, Bhai, and random 21^st century meaning-making had to offer. Fire, flame, music, bubbles, knots, turmeric, dance. We didn’t really need any of it, as there was no possibility of missing the light of love between this man and woman shocked to find themselves loved and cherished by one another. Thank God their kids didn’t give up on them!

There is no way to out-bully bullies. I may be best to ignore them; starving them of the attention and fear they crave. Only their children can reach them, after all.

But it would help for those of us they are not likely to attack, to speak up for love. Especially those of us who they think look like people who agree with them. Instead, we should encourage every bit of every kind of committed love it is possible to nurture, bless and protect.

Love finds a way.

Rev Dr. Christoph Patrick Bounds

The life of Reverend Dr. Christopher Patrick Bounds doesn’t fit in a blog; it hardly fit into Memphis! He and the Bounds brothers once opened for the Temptations on Beale Street and he knew the labyrinth under those streets working with public works department. And, oh my, did he do public work as the soul of the “Memphis Model.” He and Dr. Bobby Baker built a meshwork of trust in a city with almost none, certainly none that crossed over the broken boundary zone between the powers, principalities and structures of faith that kept dreaming of mercy and justice decades after Martin preached his last sermon down the street at Mason Temple.

I knew only a shred of this great life. Technically, he worked for me as a chaplain at Methodist LeBonheur Healthcare, but I was never confused about who knew what to do and why. He and the Reverend Dr. Bobby Baker once took me to breakfast after the Congregational Health Network was rising up from the delta mud; they told me I needed to hire more white people to balance the risk of the work being dismissed and targeted as just Black: “surely you can find some!” Chris lent his considerable store of trust to CHN, Methodist Healthcare and me. He once took me to preach at the Historic First Baptist Church of Millington (the white people named their later thing First Baptist, too). The congregation had come for church and found me in the pulpit; they were skeptical based on a few centuries of history. Chris explained in his introduction that I talked softly and, frankly a bit oddly about the leading causes of life; but it was worth leaning in and listening.

Dr. Bounds was never surprised by the ugly claws of injustice. He closed the door of my office and told me that while he knew I was a liberal and did not have room for Satan in my cosmology, I was dangerously exposed without some way to understand that chaos fights back when justice and mercy begin to rise up. It did and does.

He was the lead chaplain at University Hospital which put him inside rooms where justice could be carefully titrated and found inconvenient amid the pressures of big time healthcare business. He spoke in clear language that ripped the veil when quality wonks spoke of gross disparities as “opportunities.” We found, somewhat surprisingly, that our data showed equal treatment inside the ER; but that Black men died on the way at shocking rates. And the hospital had trouble keeping track of the ones that survived. Chris said these were his brothers and that they were dead.

It is hard to live with such clear vision and a heart of mercy. He was one of the few Black preachers to preach white funerals, including one for a recovering alcoholic chaplain. Their love for each other was a beacon fire in a dark land.

He spoke life in places that only spoke death. He preached leading causes of life in a funeral that released a family full of repressed anger and grief. The deacons and lawyers had to protect him. He warned me that these leading causes of life were a lot more powerful than they look.

TC and I got married in South Africa but with a blessing of the marriage on Mud Island in Memphis. Chris did the prayer which went on for quite some time. Several minutes into the prayer we realized he had wandered off into supplications for the Affordable Care Act, which somehow seemed appropriate given the many tribes attending. Pastoral love and politics were never far apart in the eyes of Dr. Bounds.

When I think of—dare I say brother—Chris, I can think of many times he spoke the urgency of justice. But I can only remember him with a smile and gentle eyes that did not give up on anyone. We knew when his love Bren passed last year, that Chris would not have much more use for this world. He passed at 10:30 Monday morning in the residential hospice he helped build, surrounded by many whose lives were dignified by his.

Team Sport

Even an electric vehicle depends on the kindness of strangers now and then. Good thing there are always kind strangers. In this case it was Mike Carnett, a car salesman in Wytheville, Virginia, 90 miles from home when we only had 78 miles of battery life.

Nifty charger at Pipestem State Park. VERY handy.

TC and I had enjoyed the glories of Pipestem State Park in West Virginia, which overlooks the ancient Bluestone Gorge. And it has a modern little free charger for both Tesla and our union-made Chevy Bolt. (I love to park next to Tesla’s who paid three times what I did for our 250 miles of range.)

We decided to take the long way home down the New River as my EV app told us about a charger in Blacksburg. From there we would have plenty of electrons to get home to Winston. We travel these days guided by clever iPhone Apps and the scattering of charging stations in in Walmarts, shopping malls, gas stations and the occasional city hall parking lot.

Even the cheapest EV (mine) has more than 200 miles of range, which is a lot more than I can go without stopping to pee. I’ve put just under 20,000 miles on my Bolt ranging from Atlanta to Cincinnati to DC with only flutters of anxiety.

But you still have to get the electricity into the battery. Our Bolt would not accept the charge at the EVGo charger in Blacksburg even after 45 minutes with a very helpful young man on the help line. No problem as we had plenty of juice to get down to Wytheville as a gas station where we had charged the day before. But, it wouldn’t charge there either, even after an hour on the phone with another delightful lady. We were now 12 miles short of the 90 to get home.

The Nissan Leaf was one of the first legit EV’s so every dealer has a free, but really slow, charger. We drifted slightly nervously across town to Dutch Miller Nissan. It almost worked. Out walked Michael Carnett, who poked and joked as salesman do. He noticed that the charge nozzle didn’t seem to be quite seating correctly. So I stuck my naked finger into the gizmo and dislodged a little chunk of plastic that was wedged in, probably broken off from an earlier session. A teeny-weeny trickle of electrons began to move. It was like watching a bucket of water heated by a match. So we went back to the fast Electrify America and ate ice cream as the big wire poured in 100 miles in 25 minutes. Home by dinner.

Piece of plastic in the wrong spot prevented the charger from seating correctly. Who knew? Note I still have all my fingers even after fishing it out from amid the electronics.

Electric vehicles are still vehicles with thousands of moving parts. There is no oil to change or engines to pour gas in. But EV’s are still complicated machinery built to ride up and down mountains at high speed. Stuff happens in the real world.

I can’t wait for the deluge of charging stations after Senator Coal Mine (a compliment in West Virginia) changed his mind and permitted the future to edge into our lives last week. I don’t know how our Nissan friend votes or what he thinks of global warming. I know I was grateful for his practical curiosity and kind spirit. It’s gonna take all us strangers showing a little kindness to get to the future.

Sunset at Pipestem was still worth all the adventure.

Plant

The morning after Ruth Bader Ginsburg completed her journey and handed on her legacy, I picked up six Linden trees from a nursery south of town. The county bee association had arranged a bulk purchase of the trees, known by their “small, pale yellow, fragrant flowers in clusters.” Bees and their human friends like the honey which is “white with a slightly aromatic flavor [and] when fully ripened in the hive it is considered one of the best table honeys,” according to John H. Lovell’s Honey Plants of North America. He states that “hot, clear weather and a humid atmosphere are most favorable for the secretion of nectar. Small drops may then be seen sparkling in the bloom; and the bee may obtain a load from a single blossom.” Worker bees, every one of which are female, would have liked RBG a great deal.

Our local county bee association arranged for us to buy Linden trees as a group. Bees and beekeepers will appreciate this in 10 or 15 years. I bought six to help somebody who will probably never know me.

It is cool here in the Carolinas, which is bad news for drones. Every morning below the hives I find drones that have been escorted from the hive, some with force, as they are no help in the rigors of winter. The girls don’t tolerate big and useless creatures. I think I know how they would vote, especially following the loss of RBG. Maybe I’m wrong. I didn’t ask anyone in my bee Association how they were voting. My closest bee friend is also the man I’d call in the middle of the night, if I needed something. He’s a thoughtful and kind man, whose vote will cancel mine.

The Linden trees will not help my bees today or in their eight-week lifespan. They may not be much help to me either for the similar reason. You don’t plant a tree for today; you plant for the blossoms it will provide to others who may not even know your name. A few weeks ago, we harvested honey from nectar from trees Moravians planted without knowing that me and my bees would thank them someday.

Democracy–fragile, tender and organic–is like that. A group can clear-cut it to make sticks to match their stones and beat those they consider enemies to pulp. Win! Every democracy that has ever been experiences its own failure, sometimes death. But we try to construct agreements to weather the unpredictable fire and storms of human social life. We try to anticipate how our best selves might survive our occasional worst. The young experiment called the United States has done pretty well as these things tend to go considering the potentially fatal compromise at our root—slavery and later toleration of decade after decade of gross disparity.

Some consider those issues to be in our past, exaggerated to make the current administration look bad. Not Black moms with young men for whom they are afraid to jog down the street, drive across town or bird watch. And it is not in the past for any public health department watching the COVID data replicate the pattern of almost every other viral phenomenon from cancer to gun-shots, metabolic syndrome to environmental pathologies. Case and Deaton, in their landmark work around diseases of despair shocked the world by tracing the decline in American longevity rates to working-class white men experiencing structural vulnerability that denied them a way to make an honorable living. Humiliated and trapped, they are experiencing something not entirely unlike the phenomenon common to Black men for four hundred years. As usual, the mostly White elites channel that outrage in ways that seem illogical against the Black and Brown men, not those driving the structural causes. The humiliation is so painful that it cries out for immediate release, logical or not.

Some empathy and respect would help, although likely to be lost in the cacophony of internet-speed clang and gotcha. Empathy develops slow, as slow as the speed of trust.

Another friend, Mike Heisler, sent me a book this week by Timothy Snyder, “On Tyranny.” It is “20 lessons from the 20^th century” about how to live in these times of liquid anger and fragile polity that RBG hoped to outlive. Snyder fears the people Linwood trusts, just as Linwood fears the people I trust. Lesson 12 is “make eye contact and small talk.” Synder says that “In the most dangerous of times, those who escape and survive generally know people whom they can trust. Having old friends is the politics of last resort. And making new ones is the first step toward change.”

Justices Ginsburg and Scallia were friends who enjoyed each other’s company enough laugh. My daughter Lauren had dinner with Rex Tillerson at the opening of one of her plays (he, a great patron of theater!). Linwood and I will plant Linden together 44 days before the election. I’ll cheer for his daughter’s basketball team, even if I don’t for his candidate. In a sense, that makes no sense. But democracy is not about logical sense—certainly not about winning. It does help messy humans live in between clarities when the best we can hope for is non-violent compromise. It good for muddling our way when nothing can make complete sense. Good for these times.

I feel exposed by the loss of a tiny 87-year old justice in the same way I did with the loss of John Lewis two months and two days ago. They deserve to rest in peace, honored by grateful generations. We haven’t earned that peace or honor, but there is still time. Can anyone be confused about how to honor them? Respect the structures of legal process, support social institutions, the dignity of professional ethics, the essential decency of labor serving the good of all people. Have faith. Vote.

And embrace the process of planting for others to harvest. I gently free the Linden from its plastic container, tenderly loosening the roots. I put my hands into the soil of the hole I’ve dug so it can welcome the roots home. I am not the Linden, or the soil, much less the rainfall or sun. Just one human grateful to have a chance to give life a chance.

Four trees in a trunk, two more in the passenger seat. Planting for the future sometimes requires looking a bit silly today. I’m okay with that.

Thanks for the fish

Sunday morning I found myself, an incurable optimist, preaching perched on the chasm of doom, 46 hours into a Trump presidency. Green Street United Methodist is the archetype of the raggedly dogged social action church. The kind that Newt things is dead, when, actually, it’s not even tired. But Sunday was still a tough sell for hope.

The first lectionary text for the day was better suited to the more triumphal congregations; it’s the one from Isaiah, about how the light is now shining out of deep darkness. I skipped that one, muttering. Here’s the thing; nothing in the scripture helps us much right now, if the subject is democratic process. We are way off the biblical map, since the canon closed 9 centuries before the Magna Carta, 13 before European convicts settled the Carolinas, 14 before the Moravians came down the Shenandoah to what is now precinct 601 in Forsyth County. It was 16 centuries before anyone but white men could vote in anything worthy of the name democracy. Jesus didn’t vote and nobody voted for him.

So there is no relevant political guidance to found, although I will point out that there is a lot in the Bible that the absolute rulers found comforting. Every king since Constantine had their very own Christian chapel and Christian chaplain. John Wesley isn’t a lot of help either. He thought his American followers were way off the rails with the democracy thing. He opposed the revolution, supported the King and scolded all of our founding fathers for their childish overreaching.

It’s only quite recently that it occurred to any theologian that people of faith could create a democratic government with qualities of mercy and justice. And they never would have imagined that once we had it, we would let it float away on a froth of nonsense. How has the brief American experiment come to this? Especially now amid a vast tide of rootless suffering on a melting planet. This is simply beyond the imagination of any of the biblical authors except maybe whacked out Ezekiel and the inscrutable dude who wrote Revelations.

I don’t know about you, but I’m attending the Democratic party precinct 601 meeting next month. I’m ashamed to say it will be my first meeting. Perhaps you have many such missed citizen opportunities, too. Quit missing them. Programs and policies laboriously put in place over decades are about to evaporate at the clumsy hands of people who know not much of anything, much less what their actions will do those with the least capacity to absorb one more blow, one more insult, live with one more burden. Put your phone down and show up.

The Bible doesn’t help us know how to fix democracy; but it does have a lot to say about how to live without having power and even more about not needing it.

You don’t need Ezekiel or the Revelations dude at a moment like this. Head for Jesus. Look at what he did right after his mentor John was arrested by Homeland Security. Herod didn’t need to tweet his move; everybody knew his appetites and paranoia; it was just a matter of time till he went after John like someone we know went after John Lewis. Jesus was part of John’s movement, so wasn’t surprised by the arrest. When Herod made his move, Jesus headed for the hills. Then in utter vulnerability he came back down, started forming and collecting his confoundingly unexpected movement. His was not like John’s, except in its radicality. Jesus’ radicality went much farther and in a different direction than your normal righteous protest. It was marked from the first by a ridiculous amount of healing and radical generosity that made no sense. It was almost as if Jesus was declaring an end to religion, not just offering a new flavor. This was confusing from the start and unsatisfying to revolutionaries and rulers ever since.

What did Jesus find in the wilderness? In the second half of my life, I find myself going to the wild places more and more. Two weeks after the election I was in the wilderness end of the Grand Canyon down a mile from the rim near the river. On the way back up, I learned a lot as we were caught in a winter storm.

As we picked our way up the trail, we heard stone move high above us, then bounce once, twice, three times and, after a long silence a swinging sword, a sharp crack more like a cannon far below. Even through the sleet and wind, the sound cut hard with menace even though we knew the Canyon wasn’t thinking about anything but gravity.

Nature and the fundamental drivers of large scale change do not care what humans think, feel or tweet. The Colorado plateau tilted up over millions of years, draining an ocean that cut like a saw through a billion years of rock in what by geologic standards was a relative handful of years. It carved a cathedral. But, I don’t even think the Canyon knows or cares about its own beauty.

Don’t worry about the Canyon. The climate deniers will be long gone before another few rocks fall; we will all be entirely unremembered before the river cuts another quarter inch from the basalt floor. This is the natural fact Jesus would have learned in the wilds east of Jerusalem.

I think Jesus went to the wild places to remember another natural fact more preposterous than all the canyons on earth; that amid all the harshness, fragility and loss, loving kindness survives. Humans care and care for each other, even as blood, race, wealth, politics, religion and ethnicity fall like nameless stone from the cliffs. The rocks fall, the kindness survives.

What could be more obvious than the fact that everyone who has ever lived died, felt pain and knew sorrow. We know it for ourselves and we know it for all those we love, too. Bitter resignation makes sense. But generation after generation, we find lovingkindness.

Life is fragile, short and harsh, THEREFORE be radical in your love.

My Mom died a few days short of 18 years ago. She was a practical person not given to symbol. I’m more of a romantic, so when she was near death, I took her hand and asked her if she had last words for me. She looked at me and said, “no, I think you’ve got it. You’ll remember what you need when the time comes.”

Today is a time for us to remember what Jesus told us. We need it now. Wayne Merritt, a Baptist drinking buddy who taught me Greek, said that Jesus’ message was that you will know the truth and the truth will make you odd.

Jesus came out of the wilderness and gave himself to healing —and never stopped, even for the Sabbath. He said that he would stop healing when his Parent did. How preposterous; how human, how holy; we don’t know whether to laugh at him or cry for how strange that is to us.

And what did he do beside healing pretty much everyone in sight? What does he tell his movement to do? He doesn’t give them a box of tricks to win anything at all, but a way to live; And what a crazy way! How happy are the humble, those who know sorrow, who claim nothing, who are starving for goodness. Here it shifts: How happy are the merciful (not desiring to show mercy, but doing it); and so too those who are actually sincere and those who do the work of peacemaking. And, here it gets even worse: happy are those who suffer persecution for the cause of goodness, especially when people tweet about you and make things up entirely. If you suffer for living a true life of radical generosity, how lucky you are!

This, Jesus says, is what salt is for, what a light is for, what we are for.

He keeps the radical pedal down, which must have been a shock to those just looking for some free medical care or to get some demons released. Jesus said that anger is as bad as murder! Anyone who calls someone a fool commits a serious crime and that anyone who says someone is lost is himself heading straight to the fire. Recently, I happen to frequently call a particular group lost fools, which makes me guilty of both of those. I wish Jesus would be more reasonable and supportive of our movement.

But he didn’t get more reasonable; he just keeps getting worse. Don’t tell people that God will guarantee your promise, no eye for an eye, no hitting back and if the cop makes you do one mile, give them another. And give to anybody who asks anything (I can tell you that’s dumb; that’s why I ended up in the pulpit!).

On and on, page after page, without a single tip about how to beat Herod, his deeply annoying glameroti and his horrible ever-grinning children. “Jesus…..is…..impossible,” every king and king-hater has said for two millennia.

“Comfort my people, for in the darkness we have a seen a great light.” But the light of Jesus is not the light we want. It is not a way out or a way over, but a way through; a way to live day by day, year by year, even generation after generation after generation, if we have to, waiting for the promises of god for mercy and justice to be realized. And what do we do while we wait for the big show? Go do mercy and some justice, that’s what. Jesus’ promise is that you and I can live this way, The Way, the only way which gives life a chance at all.

Come and be part of the end of all fear, especially the fear of all death and all that claims the power to kill. Come and give your body and mind to The Way that leads to life. Give yourself away, every bit and you will feel the life flow where once you held tight to your little fears and hopes. Give it away, every bit. Be part of the healing and don’t start big. Before you make a big holy show of it, think of your brother, sister, former spouse or left-behind friend; go make peace with them first. Come away from the anger and scheming. Quit bargaining and holding your minor gains as if they will last. Live this way now and you will find life flowing freely, abundant, overflowing beyond all measure at all.

You might point out that, technically, it didn’t work out so well for Jesus or those who bet their lives on his words. Herod won without a recount. Pilot, two clicks meaner; he won, too. Most kings do. But take a look at the end of Jesus story.

The story of the boats and fishers is so good that it show up in all four gospels in four different ways. John puts the story in the tender days after the assassination and scattering, when the fishermen went back to fishing for fish. Simon Peter, Thomas, Nathanael, Zebedee’s sons and two other disciples were hiding at the lake north of Mt. Airy. Peter announced that he was going fishing and since nobody wanted to be left behind, they all tumbled in. They stayed out all night, and caught nothing. They headed back in, even more discouraged than when they started, except now hungry, too. Jesus watched from the beach across the early still mist and then called, “children, have you caught anything to eat?” (No, of course.) “Cast on the right side where its deeper and you’ll find some.” They netted so many they couldn’t haul them in. John reports that it was 153, which is like counting the beer bottles left on the lawn after beating Carolina. Peter, sure didn’t count the fish. Naked, he jumped out of the boat, pushing his way a hundred yards through waste-deep water to get to his beloved friend.

Jesus had started a charcoal fire going on the beach, expecting the haul, toasting some bread. “Bring me some of the fish; y’all need some breakfast.”

Listen to the tenderness of the one who calls us into a preposterous Way of generous vulnerability. This is a savior who knows we need to eat as much as we need hope; and that we need hope as much as we need breakfast.

Be as careful with each others’ hearts and spirits in these tender days as Jesus was that morning.

Jesus does not give us a way to beat the mean and violent, but neither it is a counsel to give way to the liars and schemers. He gives us The Way to not be like them. So do not let your fear draw you toward them or their way. They have no power over you and they have no power to stop you from living The Way of Life. Their castles are as froth on the waves. You are drawing from a deeper place, carried by a deeper current, that can cut through stone like the Colorado.

The healer is here among as we fish, and type and give away our lives in healing, or teaching or raising up the voice of hope through art or kindness. Give yourself to life-giving now, not later; save nothing back for a safer or smarter time. The Reign of God is at hand, says Jesus. I think he meant your very fingertips.

“Hey,” says Jesus, “do you want some fish?”

Mainsail

Charlie Wolfe, among my very favorite humans. His future is not determined, especially by any of the other 7 billion.

Perhaps you’ve met a human. You have noticed that we can be hard to help. Perhaps you’ve been to a planet like Earth and noticed the same thing, except 7 billion different ways. How do you help something with 7 billion moving parts be healthier?

Advancing population health depends on understanding not just the medical problems, but the drivers of health ….at community scale …over time. Those drivers are largely social and they are not determinants because none of the 7 billion of us humans are determined. Words guide our imagination, shape our ability to talk about what to fear and what to hope for. So it is a big deal to see the 100 Million Lives Campaign “determinants” for “drivers.”

It important for every grown up in any position to influence a single life to talk about life as changeable and chooseable—but shaped by power drivers that have to be confronted. This is especially true for the grown-ups in positions to influence the big social structures like hospitals or faith networks. Monday in Washington DC the Association of Academic Health Centers met to explore how their huge organizations can align themselves wit the leading edge understanding of the social drivers of health. This is a huge shift for them (us, as I am a VP of one….). They brought in the big voices including none other than Dr. Michael Marmot the author of the stunningly powerful studies of social position over time (The Health Gap.). And our friend Dr. Denise Koo one of the principle forces behind the new array of useful tools emerging from the CDC such as the Community Health Improvement Navigator. (http://stakeholderhealth.org/cdc-community-health-improvement-navigator/).

salamis The closing panel of the whole conference was our “ground game” in Winston-Salem. This was explained AND embodied by Jeremy Moseley our Director of Community Engagement and Annika Archie the lead Supporter of Health, with Dr. TC laying down the data beat like a bass player in a jazz ensemble. I had two minutes at the end to set a metaphor like a sail to catch the wind of the spirit moving where you wouldn’t expect it.

The social drivers engage the role of an hospital not just as a provider of therapies, but as a social presence—usually the very largest social/political/economic structure in a community and region. This requires us to see ourselves from a community perspective: inside out and upside down. In Memphis we found ourselves in a covenant relationship with more than 600 congregations that pulled us inside out. In Winston-Salem we have followed the deeply grounded intelligence found in some of our lowest wage workers into relationships that are not just inside-out, but upside down or, better, right side up. We were steering toward life, not just away from death.

Proactive mercy is way cheaper than reactive charity. That’s the whole and complete logic of “population health management.” But if you don’t understand the humans, you can’t expect to be proactive. Being proactive depends on the intelligence about– and trust with– the neighborhoods where the costs of reactivity are concentrated. This requires not just the preeminent brilliance of our surgeons, but of all 14,000 humans on the team. Dr. McConnell and Annika Archie embodied this new deep discovery in the video interview he did with her (and me) last week (click here).

That’s what works.

It is new for big organizations to hold ourselves accountable for social factors. That has always been on the side, a by-product, an unintended consequence. Now it is central. Some say we should think of ourselves as “anchor institutions,” but that image reinforces our worst habits of domination. What could be worse than focusing on anchors of determinants? I’m depressed just typing it!

krusenstern_mainsails — The mainsails are the ones low and large. You leave them up so the ship can keep moving even in heavy seas.

We should be mainsail organizations.

The mainsail is the large sail on a clipper ship low and strong that you leave up even amid the heaviest weather and hardest storm. This includes the storm-tattered neighborhoods you can see outside the windows of urban medical center. You leave the mainsail up because in deep and heavy water you have to keep going or the waves will overwhelm you. The last thing you need is to drop an anchor. That’s what you see in Annika, Jeremy and TC and their hundreds of colleagues setting themselves to catch the same wind of Spirit– surgeons, nurses, social workers and revenue cycle VP’s– that share a hope and mission.

You can even hear it now from some our community partners, glad that we have finally joined them in their journey toward health. They don’t want an anchor; they want to go somewhere new.

Last Saturday our own Rev. Dr. Francis Rivers received the major award from the Hispanic League of Winston-Salem honoring him (and the FaithHealth team) for leaning way into the heavy seas of anti-immigrant venom surging currently in North Carolina in creating the ID Drive. Francis’ award honored him, but also his mainsail organization–and not just the tiny part of it called FaithHealth. The medical center put up a big sail amid very heavy seas that helped other key institutions do their critical work. The Sheriff, police, DA, a network of churches called Love Out Loud, many Hispanic organizations and Que Pasa media). And don’t forget the most important FaithAction—the small faith-based organization that does the actual work of validating identity so that an ID card can be issued and trusted.

ship A fully rigged sailing ship is a very complicated thing with many sails and miles of rigging. So, too, is any network of partners committed to helping their community move away from the rocks and into a safe harbor. But none of the partners could have stepped into the heavy wind themselves, much less alone. That role was for the mainsail and a ship built for deep water.

You might be so embarrassed by all the mean hateful things religious people are doing these days that you want to stop the metaphor right there. But you’d be leaving out the most interesting part of sailing—the wind. The sail doesn’t have any power; it only catches the wind. Greek traces the same word for wind to breath and… Spirit.

We know in North Carolina that the Spirit can blow toward or away from the rocks; it depends on the skill of the sailors and the courage of those who climb up the rigging and set the sails. These are days filled with stupid religious venom, so I don’t blame anyone who wants to move culture and institutions and society without faith. But nothing at cultural scale ever happens without Spirit blowing really hard. You can stay below decks and hope for the best. Or you can find someone who know how to set a mainsail and head to deep water. Francis, Annika, Enrique and the others on the edge, live way up in the rigging where the wind blows with raw power. They teach us to its respect power, but not to fear.

Dr. King spoke realistically when he said “the arc of history bends toward justice.” It is a slow bending curve, more tectonic than sharp. We don’t choose this way or that, but lend our days to the slow bend, helping each other keep courage for the long turning. We set our sails for heavy seas and a long arc toward a horizon worth the journey.