by James P. Wind

Sometimes the most important conversations are the ones we fail to have. Take one from the complex world of modern medicine reported in the May 2013 issue of The Atlantic. The magazine’s contributing editor, Jonathan Rauch, recounts his father’s last hospitalization in “How Not To Die” (pp. 64-69). Suffering from an advanced, untreatable neurological disorder, Rauch’s father was admitted to the hospital for an MRI test. Soon he was in trouble. “I can only liken his experience to an alien abduction. He was bundled into a bed, tied to tubes, and banned from walking without help or taking anything by mouth. No one asked him about what he wanted. After a few days and a test that turned up nothing, he left the hospital no longer able to walk.” That experience led Rauch’s father to refuse to ever go to a hospital again and launched Rauch on an exploration into one of modern medicine’s great weaknesses.

What failed to happen for his father—and fails to happen for too many Americans—was something the medical profession terms “The Conversation.” Rauch’s father needed the “momentum of medical maximalism . . . slowed long enough for a doctor or a social worker to sit down with him and me to explain, patiently and in plain English, his condition and his treatment options, to learn what his goals were for the time he had left, and to establish how much and what kind of treatment he really desired.”

Rauch provides other examples of this crucial conversational failure, but then shifts his attention to a group of physicians who are trying to create better conversations. These people see themselves as “disruptors” who seek to interrupt normal hospital practice so that people have a better chance to more fully understand the decisions they are making. For example, Dr. Angelo Volandes, an assistant professor at Harvard Medical School, feels that the most urgent issue in America today is “people getting medical interventions, that if they were more informed, they would not want.” He tries to prevent this “unwanted care” by creating 6-7 minute videos with a handheld video camera that are prepared for patients and families faced with difficult treatment choices. Regularly, Volandes and his colleagues find that patients and families who slow down for this kind of conversation are declining treatment options that they might otherwise accept.

This report from the front lines of modern medicine says several things to me. First, it reveals that Americans live in a world of amazing and overwhelming technological marvels. Modern medicine can do wonders and most of us are beneficiaries of some of its gifts. However, those gifts keep us from noticing that very basic, elemental human things fail to happen—like conversations about how to have a good death. Sometimes the things that we trust the most, our resources, our power, our expertise set up momentums that work against our deepest needs and values. The results of those momentums, which we often lack knowledge about, can be great harm.

Dr. Volandes and his bedside videos are signs that we can disrupt normal patterns; new kinds of conversation can occur. Rauch’s article raises important questions about why these efforts have not become the norm and how health care can continue to improve its practice.
What about the world beyond medicine? Are there other places where certain critical kinds of conversations are not occurring? In our classrooms, laboratories, board rooms, and legislatures what powerful momentums are in motion that silence our deepest questions about what we are doing?

Here especially I think of American congregations. Many of them are buzzing with conversations. But what is not being talked about within them? Rauch makes me wonder if congregations are talking enough about decisions that their members face. Is one of the reasons that good conversations seem to be so hard to have in hospitals the fact that other conversations did not happen? Have congregations learned how to support people like Dr. Volandes who are seeking to open up spaces for new kinds of conversation in complex places like hospitals, universities, corporations, or military institutions? Have they learned how to evaluate the conversational ecology of their organizational life—identifying the conversations that are acceptable and those that are taboo, the conversations that are safe and those that are dangerous?

In his recent book, Sacred Ground: Pluralism, Prejudice, and the Promise of America (Boston: Beacon Press: 2012), Eboo Patel takes on one of America’s most volatile conversational challenges: how contemporary Americans speak about the Muslims in our midst. Patel gives an example of how he is trying to help a much needed conversation take place in our country. Patel, a Muslim, reports on how he often engages seminary conversation partners (predominantly Christians) in talk about one of Christianity’s favorite parables—the Good Samaritan story. In those conversations he slows his dialogue partners down so that they think more deeply about the identity of the hero of the story, underscoring that the only one who stopped to help the roadside victim was a Samaritan, whom we know as “the other,” an outsider. Patel then pushes further, pointing out that Samaritans were, for Jesus and his listeners, heretics—“people of a different faith.” Sounding a note similar to Rauch’s warning about dangerous momentums, Patel speculates that “perhaps it was their expertise that kept them from helping.” Then he says something that many routine Christian conversations about the parable do not make room for. As he points out that “it is the Samaritan, the heretic, Jesus tells them to emulate” this Muslim invites his Christian audience to consider that “Jesus seems to be saying it is not enough to stay within the fold of the faithful, not enough even to follow the way, the truth, and the life. To attain the eternal, the story suggests, you have to engage with people who believe differently than you” (pp. 143-145). Patel helps us see that we need to be intentionally creating new conversations not just in our seminaries but in our congregations, and not just with people from our own faith tradition but with those who come from other worlds of belief, about the overlooked implications in our sacred stories for America’s welcome of Muslims. Those kinds of conversations might prevent a lot of harm.

Congregations magazine, 2013-07-10
2013 Issue 2, Number 2