Epiphany, 1996 Part 2  

Catholic Health Care Ministry

by Patricia A. King
I am a lay woman who serves as policy advisor for health and welfare issues to the U. S. Catholic Conference. I have also practiced hospice medicine and taught medicine to physician assistant students. In these roles advisor, teacher and care-giver, I have been informed by the understanding that health care requires both technical competence and an understanding of the full range of human needs.

Through the Catholic health care ministry, the Church offers a combination of technical competence and care of the whole person "in a way that fully respects human dignity and that recognizes the multifaceted causes of illness" [Health and Health Care, p. 12]. The more than 900 Catholic hospitals and long term health care facilities, present in more than 160 dioceses, represent the visible presence of the corporal and spiritual works of mercy of the healing ministry.

Many of the Catholic hospitals are the last intact institution present in our poorest inner city neighborhoods and our rural small towns. In each of these settings, the hospital and its staff offer an opportunity for the "special sensitivity towards those who are most in distress, those who are extremely poor, those suffering from all the physical, mental and moral ills that afflict humanity including hunger, neglect, unemployment and despair" [Pope John Paul II, 10/2/79].

The witness of the Church's healing ministry is not confined to institutional settings. Many dioceses, such as Richmond, VA and Cleveland, OH, have parish based nursing programs and partnerships between parishes and out­patient clinics, hospitals and long­term care facilities. Thus the full range of resources, including sacramental ministry and prayer, are integrated into a wholeness of healing ministry.

These realities are of special concern to lay women and men in our Church because more lay persons are assuming leadership roles in the Catholic health care ministry. Many of the orders of women and men religious who originally sponsored health care institutions find themselves with fewer members to provide leadership in their institutions. The economic pressures of an increasingly complex health care marketplace, as well as the aging of religious congregations, have resulted in more mergers and partnerships between Catholic institutions and other non­profit and also non­Catholic health care providers. While these changes are inevitable, their implications for the quality of the healing ministry are uncertain.

What is certain is the richness of the resources which our Church has to offer to those in need. Not only do we have a tradition of high quality technical medical care, we have a tradition of respect for human life, at all of its most vulnerable points, and a rich sacramental and Scriptural tradition to offer to those who suffer and those who mourn. These resources are expressed through the work of those in the health care ministry both in this country and throughout the world.

Five Catholic health care systems, from Washington, Pennsylvania and Missouri, are collaborating in efforts to improve their institutional care for the dying through their vision of compassionate, comprehensive, and holistic care at the end of life. The group, known as the Committee on Care of the Dying, is developing a practical guide to be used by care givers. While these groups know that they cannot change the culture of health care all at once, they believe they must care for dying persons in a manner consistent with Catholic values. They also believe they can initiate a process that begins the transformation of the way that the dying are cared for not just in Catholic institutions but throughout the health care system.

In Romania, through the work of the Catholic Health Association, the Catholic health care ministry has raised funds to establish a day school for children with Down's syndrome. These children were the last to receive treatment during the Ceaucescu regime. Now, in its fourth year, the school has between 15 and 20 students. Three children have been mainstreamed into the public school system. In addition, the funds have been used to establish two group homes in Cluj for disabled children waiting for adoption; to open a kindergarten in the poor section of Bucharest; and a nursing school.

Increasingly, these multi­faceted resources and activities must be nurtured and sustained in a pluralistic environment by lay women and men. The increased role of the laity in the health care ministry offers an
opportunity "to carry forward the work of Christ himself under the lead of the befriending Spirit ... [since] Christ entered this world to give witness to the truth, IO rescue and not to sit in judgment, to serve and not to be served" [Gaudium et Spes, pare. 3 ]

The health care ministry is an integral part of our Church's ministry and its outreach to persons and communities in need. It would be a grievous loss to the Church and to our nation should the Church's healing presence not be sustained by faithful and committed lay persons.
Patricia King is the Policy Advisor on Health and Welfare Issues for the U. S. Catholic Conference

The Real ER

by David F. Guerrieri, MD

The picture of life painted by a physician's work in a busy emergency room shows characters living their lives near the edge where the limits of life and the borders of mortality are found, where final things confront us, and where no decisions are inconsequential. I've often remarked to colleagues that it is good that we don't know just how thin is the ice on which we skate or how close to edge we walk.

The ER is most like military combat, with hours of boredom interrupted by moments of terror. One often hears analogies between the battlefield and the ER. A searing experience I had at the forward edge of the battle area in Vietnam episodically returns to the periphery of my consciousness, an eerie experience from Vietnam.

One dark night during a particularly close­in attack against our position, I went to the forward most bunkers to assure that the soldiers were both well and confident in their defense. Noticing one soldier standing to the side, unarmed and apparently quite nonchalant, I approached him to discover why he was not better occupied in the defense. As I neared him he looked frail. The starlight glinted off his rimless eye glasses. In that same starlight I saw the insignia of an army chaplain. I was about to ask what the Hell he was doing that far forward when his easy smile unnerved me. We soldiers were agitated by the action that lie ahead. That chaplain was fearless to the point of insouciance. I had the distinct impression that he knew something I did not know. As it turned out, he knew Someone I did not know. And so it has been in the emergency room. On my way to work I often find myself whispering, "Saint Michael the Archangel, defend us in battle."

Don't misunderstand me. No one wants a physician whose wits are sharpened by angels and whose hand is guided by a patron saint. It seems that Divine Providence acts among us in a manner calculated to bring out the best in us when only the best will do. It's all quite mysterious.

Frequently I recall the case of the girl with the high­pitch voice and the young man who died on us. The young girl was about twenty, well dressed, who was involved in an automobile collision. She had been thrown forward against the dash. When the paramedic took her from the car, she was so anxious she could hardly breathe and her voice had an unseemly high pitch. But she did not appear badly hurt. In fact, there wasn't a drop of blood on her. Others in the collision had been pretty badly mauled and were taken to trauma centers.

In the emergency room I assumed my customary place at the right side of the gurney. The patient's agitation was manifest. I tried to reassure her but she was inconsolable. My quick initial assessment showed her respiratory rate was fast and rising, each breath was shallow, and the pitch of her voice was rising. The nurses disrobed her. The secondary survey revealed that the bellows of the chest were not expanding much and compression of the ribs suggested likely fractures. The problem was obvious, she probably had a pneumothorax, air gathering between the interior chest wall and the exterior of the lung due to a puncture of the lung in this case by the sharp edge of fractured rib.

Now I can confidently assure you that a physician would like to have a chest X­ray and the leisure to study it before he rams a plastic tube the size of your index finger through your chest wall, this being the only known treatment for a tension pneumothorax. Instead I ordered a chest tube tray immediately and with a #10 blade deftly opened her chest wall above the right fifth rib enough to place my finger through it. This opening emitted an audible puff of air. The tube went in and the hole was sealed with stitching around it. Her respiratory rate came down. The pitch of her voice dropped. Together we backed away from the edge.

The radiologist reviewing the films next morning remarked that when the first chest film shows a chest tube, he knows it was a wild ride through the night. Reflecting on the case, I knew that if I sent the patient for a chest X­ray, therapeutic intervention would have come too late. Clearly, mine was the right decision. Somehow my education and training had conspired to bring me to that time and place where only one act would reverse an inexorable downward spiral, an act that seemingly contravened the first injunction to do no harm. Some would say that the patient and I "got lucky", but that is what the unbelievers always say. If luck were operational, neither one of us would have been in the ER that night!

The young man who died on us was brought in by the paramedics. He was unconscious but still breathing. His coma was deep. He had collapsed in the physics laboratory of a local University. A quick neurological assessment revealed that his left pupil was dilated and unreactive. I slipped a plastic tube through his nose into his trachea in order to assure that we could breathe for him if the pressure inside his head suppressed his respiratory drive. I called a neurosurgeon to see him but it was hopeless. He died a day later. There was nothing anyone could have done to reverse the inexorable course of an intracerebral hemorrhage.

Soon after the neurosurgeon had taken charge of the case, I went to a small room away from the ER where I often had gone to relax. On the way I passed a nurse whom I knew well but I could not speak. Hidden I wept openly. There was nothing I could do in the face of death. I guess it was my powerlessness that shook me deeply and I came to accept what I could not change. We may resent being humbled, but humbled we will be.

How paradoxical that the proximity of death in the ER leads us to treasure the life we have and to struggle so mightily to preserve it, to push back the darkness, as it were, and preserve the light in the eyes of all who have trusted us to help them. Every patient merits our serious efforts within the limits allowed by our scarce resources. Fear of legal liability or concern for our professional reputation do not drive our need to do it right. In fact it is the love of life that drives us.

Inexplicably one comes away from the carnage of the ER with the conviction that life is unique and precious and never to be squandered in selfishness. I have pulled the white sheets up over many of the deceased. I have borne the sad news of their demise to the next of kin in the waiting room. But as the years pass, death does not become routine or banal but arouses a resolve to diagnose more smartly and intervene more deftly.

Preserving life that otherwise would have been lost to the anonymity of an unwritten history is the touch of the Divine in our working lives.

Dr. Guerrieri, an emergency room physician practicing in California, served as an artillery officer in Vietnam where he earned the Silver Star and the Purple Heart.
 

"Is it then a crime against others' freedom to proclaim with Joy a Good News which one has come to know through the Lord's mercy? And why should only falsehood and error, debasement and pornography have the right to be put before people and often unfortunately imposed on them by the destructive propaganda of the mass media, by the tolerance of legislation the timidity of the good and the impudence of the wicked? The respectful presentation of Christ and his Kingdom is more than the evangelizer's right; it is his duty." Paul VI / Evangelii Nuntiandi, No. 80
 

National Federation of Catholic Physicians' Guild

Each local guild is autonomous, and carries on various activities as its members decide. Local guilds vary in size from six members (the minimum number), to over 400 members in some of the larger metropolitan areas. Some cities have two or more guilds. And there is a trend to form independent guilds in each major hospital in some of the larger cities. Activities include retreats (still very popular as they were in the very first guild), health care of the religious, fostering Catholic medical student groups, cooperating with local charity organizations in the care of the sick and the poor, sponsoring and staffing medical missions in the United States and foreign countries, actively supporting right­to­life groups, and providing advice and counsel on medical­moral matters to the local ordinary.

Each guild is encouraged to conduct one or more membership meetings each year at which expert speakers would discuss current medical­moral issues. This might particularly be held on or near the feast of St. Luke (October 18), the patron saint of physicians and dentists, in conjunction with the celebration of a White Mass for all medical and paramedical personnel in the area. The National Federation will assist local guilds in obtaining speakers. The Federation also sponsors a national annual meeting in the Fall of tho year. The Federation works closely with the Catholic Health Association, the Catholic Press Association, the National Council of Catholic Laity, and all National Right­to-Life groups. The NFCPG is affiliated with the International Federation of Catholic Medical Associations (IFCMA) and periodically co­sponsors international meeting in the United States. The NFCPG supports all worthwhile medical mission programs, and is particularly supportive of the Mission Doctors Association which is headquartered in Los Angeles, CA. The Federation is represented on the Health Affairs Committee of the United States Catholic Conference (USCC) providing medical expertise for the Bishops' Conference.

For more information, write or call: National Federation of Catholic Physicians' Guilds, Inc. 850 Elm Grove Rd. Elm Grove, Wl 53122, (414) 784-3435
 

NEWSBRIEFS

Paulist Evangelization Training Institute is presenting the 8th annual 5­day seminar Creating an Evangelizing Parish . Sixty­ five percent of past participants ranked the experience "excellent." Three sessions will be held; 6/25­29,7/1620, 7/30­813. info: Barbara Dolan, PNCEA, (202} 832­5022.

The GoodNews Letter is on the World Wide Web!! Come visit us at http://niwg.op.org/niwg/ and find John Burke at BURKEOP@aol.com

John Burke will conduct: a week long Parish Bible Mission at Sacred Heart Catholic Church in Cut Off LA on Feb 24­March 3 (Info: Rev. Francis Legendre (504) 632­3858) and at Mt. Calvary Church in Forestville MD on March 23­27 (Info: Rev. George Golden (301) 735­5532); a Bible Seminar at the John Paul 11 Bible School in Alberta Canada March 4­15 (lnfo: Stan Kroetsh {403) 736­3833); a Biblical Spirituality for Parish Priests retreat at the St. Joseph Christian Life Center in Cleveland OH April 28-May 2 (Info: Donna Collins (216) 531 ­7370).

The National Council for Catholic Evangelization will hold their 13th annual national conference on June 11­15 in San Diego, CA focusing on Proclaiming the Gospel of Justice . Info: NCCE PO Box 1260 South Holland ILL 60473­1260 (800) 786-NCCE.

The National Federation of Catholic Physicians' Guild will hold their annual meeting on Nov. 6­9, in Phoenix AZ. NFCPG also publishes Linacre Quarterly, a periodical on medical­moral issues. Info: Michael Herzog, NFCPG Inc. 850 Elm Grove Rd. Elm Grove, Wl 53122 (414) 784­3435.

The GoodNews Letter is published three times a year by The National Institute for the Word of God. Story suggestions, news items, and correspondence are welcome and may be forwarded to the Editor.

Epiphany, 1996

The National Institute for the Word of God, 487 Michigan Avenue, NE Washington, DC 20017 Editor, Mary Ann McGuire, Ed D.