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The recent pop song “Stand by You” by Rachel Platten includes the following lyrics:

Even if we can’t find heaven, I’m gonna stand by you
Even if we can’t find heaven, I’ll walk through Hell with you
Love, you’re not alone, ’cause I’m gonna stand by you.

It’s an uplifting anthem even though, if you really think about it, if you’re actually walking through hell, having someone beside you would probably only marginally improve the experience. Presumably the language is figurative, and the message is “I’ll be with you even through the hard times.”

The video for the song doesn’t contain any walking-through-hell scenes, either literal or figurative–not that I could tell, anyway. Instead, it shows Rachel singing and people showing warmth and caring to others. At one point, what looks like a church choir joins Rachel, clapping and dancing enthusiastically. Maybe no one is finding heaven, but they certainly seem optimistic in their pursuit of it.

All this reminds me of my church. I wrote last September that we had dwindled to just a few members and were considering disbanding. That prospect troubled me, since those who remained had invested so much in the church, serving and supporting one another. Though the situation looked grim in one sense, in another way I thought we were exactly what a church should be. I wrote about our conversations with each other then:

“It felt at the meeting like we had spent years climbing a mountain, slipped back down nearly to the base, and were wondering if we had it in us to climb the mountain again. But what if the mountain has nothing to do with how many members we have or how many attend Sunday services? What if the mountain we needed to climb was to be faithful to Christ through hardship and to let him shape us so that we became more like him? In that case, judging from what happened at the meeting, we’ve already climbed the mountain and are at or near the summit.”

We decided then to continue as a congregation, and worshiped together every week for almost five months. We had a few more people who were once peripheral members attend more often, but for the most part it was the same dozen people who continued praying for each other, singing together, studying the Bible, and sharing our joys and sorrows with each other.

Recently we had another meeting. The pastor said that, though we weren’t in financial difficulty yet, we couldn’t afford to pay his salary for an extended period of time. He was feeling pulled to be in a larger, more conventional church. A few other people expressed the same desire, and some of the rest acknowledged that, as much as it pained them, the best decision would probably be to disband. We all said that we want to maintain our relationships, and we made plans to meet regularly with one another once our Sunday morning services stopped. Our last worship service as an organized church was yesterday.

I am said about this. I’m consoled, though, by the thought that, during our time together, we truly constituted the church of Christ, and did so more purely and maturely than I had ever seen before.

What does all this have to do with finding heaven? A few weeks ago, I ran across a reference to something Jonathan Edwards said about the church and heaven. Edwards asked, how is the church like heaven? He decided that what made the church on earth like heaven wasn’t the signing or the Bible reading or the sermons. It wasn’t the meetings and activities that members attended or the charismata, the gifts they possessed. It was love. D.A. Carson, who summarized what Edwards said about the church, added:

“The greatest evidence that heaven has invaded our sphere, that the Spirit has been poured out upon us, that we are citizens of a kingdom not yet consummated, is Christian love.” (In Showing the Spirit: A Theological Exposition of I Corinthians 12-14)

So, having been part of a church where everyone loves everyone else–and lives out that love by listening, encouraging, reaching out, and helping–is to have found heaven. My church no longer meets, but still it lives on, as long as that love endures (and the Apostle Paul promises that it endures forever–see I Corinthians 13:13). Sure I’m sad, but mostly I’m grateful. Why did God bless me by letting me experience heaven while still on earth? I may never know. But, having found heaven (or, rather, being found by it), I look forward to the next time I’m there, regardless of which side of the grave that happens.

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This past Wednesday my church had the sort of meeting no church ever wants to have. We met to decide whether to continue as a church or disband. When I joined the church shortly after moving to the area three years ago, I never thought things would come to this. It was always a small church, but it was vibrant, with lots of college students and young professionals. Church services were (and still are) joyful but also a time for deep, quiet reflection; sermons were rich and encouraging. The church wasn’t really growing, but that was largely because so many of those who left had been inspired to go to seminary or enter church work of some kind. The future seemed bright.

There were a few problems. We were a small church, and there weren’t many people to do the work that was entailed in keeping everything going. Some members started complaining about the workload. About a year ago, a few members left; so as not to burden the remaining members, the steering team cut back on some things we were doing. That affected programs, and some people became dissatisfied that the church didn’t have the programs they wanted. More people left. In about the past three months the loss of members cascaded, and, finally, there was a church service in the middle of August that nobody attended (that’s not quite true; the pastor and five people were there). So, the natural question became, should we continue or just disband? And if we continue, how can we become a sustainable church again? Thus the meeting.

Twelve people attended, plus one via Skype. There was a couple in their fifties and their daughter, a couple in their forties, two couples somewhere around 30 (I’m bad at estimating ages so this sentence may be mostly inaccurate), the pastor, and his wife. I was the oldest person there. A teenager, daughter of the second couple, joined us after work. Our only remaining college student had a class and couldn’t make it.

The pastor and the head of the steering team had drawn up a list of four options, three of which were to go on in some fashion and the fourth of which was to disband. We each talked about how we saw the church and what we thought would be the best course of action. Several people mentioned being discouraged by the work that it would take to rebuild the congregation. A couple with young children said they thought it might be best for their kids to go to a church with more programs. Someone asked our pastor whether it would be a relief if he no longer had to lead a struggling church. He didn’t think so, but said he was shaken when only five people came to a service and thought he didn’t have the energy to cope with that happening many more times. His wife broke down when she talked about how hard it is to set up for a service not knowing if anyone will come.

At the same time, about half of us were leaning toward continuing. Even those who were leaning the other way talked about not wanting to give up the community we have together. We are, indeed, a family to each other. We have gotten to know each other incredibly well and care deeply for each other. One person who is thinking of leaving asked, “But couldn’t we still meet together to talk about faith?” Isn’t that kind of what church is? The teenager said she loved her church and that all the adults treated her like a person, not just a kid. Everyone was open; everyone got support even if they expressed views different from the rest of the group. We couldn’t find resolution, though. Toward the end of the meeting I didn’t want the church to disband but I had a sense of dread that we might have to do so. I think I wasn’t alone in that dread.

We decided to wait one week before making a decision. I hardly slept at all that night; I was in misery since I couldn’t see a way forward. Early the next morning, as I reflected (or maybe obsessed) on the meeting, it dawned on me that something remarkable had occurred there. These twelve people (I won’t include myself because I was the last of those present to join) had invested themselves in the church without holding back. Everyone had picked up the slack for someone else who either wouldn’t sign up to help or signed up and didn’t follow through. I suspect everyone felt abandoned by members who seemed committed or even led the church (did I mention that all but one member of the steering team left this summer?), then disappeared. If anyone had a right to throw up their hands and walk away, to rail at those who left, to blame the pastor or leadership or God or anybody else that came to mind, to say “I told you so” about suggestions not taken and warnings not heeded, to remind us all of how much they had done, it was these people.

Yet none of them did. No one said they wanted to walk away in disgust, no one vented, no one blamed.  Every person there was open, often to the point of rawness, about their feelings, and none of these feelings were toxic. Everyone listened, everyone empathized, everyone encouraged the others. More than anything else, everyone loved each other. I believe that God’s Spirit was present, ministering to each of us through everyone else. Thinking back over my sixty-plus years of participating in various churches, I could recall only one other meeting in which I sensed the Spirit was present to this degree.

I shared these thoughts with a friend who has been a pastor’s wife for over thirty years. Her take was that God must have been working for years to get us to that point, stripping away the illusions and false hopes so just love remained. She and her husband had a similar experience once early in their ministry. The church they were then serving went through a tremendous struggle and were left with just a faithful few. They considered closing, but didn’t, and now are serving their community in wonderful ways. She said something like this: “God doesn’t accomplish his purposes by building big churches with lots of programs. Christ works through small groups who have been purified for his purpose. You’re one of those groups.”

Maybe we are. I was still left wondering what it would mean for us to be a successful church. We’ve been thinking that we need to build our numbers up. It felt at the meeting like we had spent years climbing a mountain, slipped back down nearly to the base, and were wondering if we had it in us to climb the mountain again. But what if the mountain has nothing to do with how many members we have or how many attend Sunday services? What if the mountain we needed to climb was to be faithful to Christ through hardship and to let him shape us so that we became more like him? In that case, judging from what happened at the meeting, we’ve already climbed the mountain and are at or near the summit.

And what about all the programs and activities that other churches have but we don’t? Some of those seem appealing to me as well. But aren’t those programs and activities for the purpose of spiritual formation–to change our hearts and minds so we become more like Christ? If that is happening to us in such a powerful way already, how many more programs do we really need? How much sense would it make to disband and go to other churches so that we can get into programs to teach us how to get what we already have?

How about the kids? We do have a worship time for them during the sermon, but they are missing out on the rich array of educational activities that many churches have. We probably can do better. Still, there are lots of kids who grow up in other congregations going to those activities and end up disliking the church and keeping their distance from all things religious. Are they really better off than our kids, all of whom seem to love our church as much as the teenager in the meeting does?

None of this means that we aren’t in a difficult position. We aren’t in financial straits yet, but will be eventually if something doesn’t change. At this point, I don’t know if we’ll decide to continue on. Still, since the meeting, my thoughts about what makes for a successful church have changed totally.

A couple days ago, I sent an email to those at the meeting, suggesting that maybe God’s intention all along was to bring us to this point where we love each other the way we do. I added that our church has become the most successful church I’ve ever been a part of. Just so they wouldn’t think I’m nuts, I carefully specified that I was using as my criterion of success that we become Christ-like. They know me  well, though, and probably knew before the email that I can be kind of nuts. That’s OK. They love me anyway.

So, we’ll meet again on Wednesday September 16. I ask for your prayers for us. And while you’re at it, pray for yourself, too, that, if it hasn’t happened up until this point in your life, you will someday be part of a community that loves God and each other the way we did on Wednesday. As I know all too well, being in that sort of church can be painful, but the joy far outweighs the pain.

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UPDATE: When we met on Wednesday, we decided to continue meeting for at least a year. We’ll focus first of all on getting closer to each other and finding a way of worshiping that those wary of God or church might find easier to participate in. We started that process with our worship service today (9-12-15). I’m excited about what God is doing among us!

Persuading secular moderns that they should be holy is quite a challenge. Aiming this message primarily at young adults, who are bombarded by ceaseless messages to be successful, in the know, popular, or any number of other things besides holy makes the task all the more difficult. Brian Christopher Coulter, pastor of First Presbyterian Church in Aiken, South Carolina and author of Be Holy: Find Identity/Find Belonging/Find Purpose, takes on the challenge. Coulter believes that seeking holiness is not a dreary religious obligation but something that will enrich life. He claims, “We are not invited to be holy because God needs working drones; God invites us to be holy because it is a better way for us to experience and live life (p. ix).”

Be HolyCoulter begins by alluding to the emptiness, thoughtlessness, and insecurity that characterize much of modern life. He isn’t interested in exploring these in any depth, though; he’s mainly interested in offering solutions. His answers come from orthodox Christianity, which is to say that faith in Christ is essential to him. This means more than accepting Christ’s invitation to “a relationship of forgiveness and mercy;” it also includes the life that subsequently becomes possible.

Coulter considers what the Bible says about being holy. To be holy is to be set apart. God is holy in that he is distinct from other gods and from creation. This holy God also sets his people apart; he instructs them to be holy. Holiness is more than ritual purity; it is a way of living in the world. Coulter suggests this way of living has three elements: “We reflect our Holy God by being set apart from all that is not holy, for all that is holy, and with all who are holy (p. 31).” These three elements then become the structure for the rest of the book: “set apart from” entails finding our identity, “set apart for” implies having a purpose, and “set apart with” involves belonging to a community.

In my initial reading, I thought Coulter was being too simplistic about what it means to have identity, belonging, and purpose. I had the most difficulty with identity. Coulter is certainly right in saying “Who we are is known, revealed, and loved by God (p. 59).” I love the quote he uses from Brennan Manning: “Define yourself radically as one beloved by God. This is the true self. Every other identity is illusion (p. 55,6).” But isn’t it more complex than this? How do we understand the political, racial, gendered, and socioeconomic aspects of who we are? How do we sort out our views of what we can know, what is, and what is good? How do we learn what our gifts and abilities are?

Eventually I realized that I was trying to read the book as a psychological do-it-yourself guide to the issues of adolescence and early adulthood. That isn’t what Coulter has written. An early clue to his intent is his allusion to Clark Kent (i.e. Superman) in CW network’s show Smallville. Clark already has all his superpowers, but he doesn’t know what to do with them. The issue he faces is not to acquire superpowers:

“It is about embracing the gifts he has been given. It is about embracing his destiny to be Superman.
“This is us with holiness. Our choice seems to be less about becoming holy and more about embracing holiness (p. 20).”

Thus, identity, belonging, and purpose are not something we have to work to acquire. They are gifts from God that we need to accept. Accepting these gifts entails living out certain practices in our day-to-day life. Coulter does a nice job of showing how practices such as baptism, Sabbath observance, prayer, and the Eucharist fit into this holy, set-apart life.

Though I’m much older than Coulter’s target audience, I read this book because I am a Christian who is interested in being holy. The book is mostly about the early stages in the journey towards holiness, but it also contains much that is of interest to those further along the path towards maturity. As might be expected given his target audience, Coulter uses many examples from popular culture–celebrity quotes, music, movies, TV, and the like. Less expected are his references to writers with some intellectual heft, including Kierkegaard, Schleiermacher, Walter Brueggemann, and Thomas Merton. Sometimes, I wished Coulter had developed further the points made by these thinkers–Kierkegaard on the longing for meaning, for example, or Brueggemann on the Sabbath. Still, the references are available for those who wish to explore them more fully, and it is nice to know that Coulter’s ideas were informed by such thinkers.

Coulter writes clearly. He pauses every page or so to emphasize his main points in a few short sentences, each standing as a separate paragraph, as in this from the section on belonging:

“Prayer builds community.
“Prayer builds relationships.
“Be holy.
“Pray (p. 102).”

These staccato-like sentences serve as useful summaries. I never did get acclimated to his use of hashtags to make wry comments, but this was easy enough to ignore. I recommend Coulter’s book not only for young adults interested in the spiritual life, but also for older adults, be they newly interested in holiness or further along the faith journey but wishing to reflect on the nature of that journey.

Note: Thanks to Chalice Press for a review copy of this book in exchange for an honest review.

I recently read Consuming Jesus: Beyond Race and Class Divisions in a Consumer Church by Paul Louis Metzger of Multnomah Biblical Seminary.  It was a book that seemed to promise an incisive commentary of the consumer mindset in American Christianity.  I found the case Metzger made to be unconvincing, though.

The first chapter is promising; Metzger provides an excellent historical account of how 19th century evangelical social concern dissipated in 20th century fundamentalism and evangelicalism.  He notes that “the approach taken by the Religious Right, the Moral Majority, the Christian Coalition, and the like over the last few decades does not exemplify an apolitical orientation or the abandonment of social policies; rather, it exemplifies an adherence to political and social policies that give the appearance of being fixated on conservative, middle-class American social values.”

Such middle class values include materialism and consumerism.  It shouldn’t be hard to demonstrate the extent and effects of consumerism in America and its churches, but Metzger puffs away ineffectively at that task.  He says things like the following: “The consumerist mindset entails giving consumers what they want, when they want it, and at the least cost to consumers themselves.”  Maybe the marketplace gives people things but it’s hard to imagine the “consumerist mindset” giving anyone anything.  Then there’s this:  “The consumerist free-market spirit disguises itself as an angel of light.”  Who is this costumed ephemeral being—this “consumerist free-market spirit”?  I suspect that Metzger isn’t actually positing poltergeists but is instead suggesting that merchants and consumers justify as beneficial their attitudes that support selling and buying.  I wish his argument didn’t rely so heavily on metaphor.  Also, there’s hardly any documentation provided here.

Metzger does make some good points about the church.  For example, he points out that the “homogeneous unit principle”—the view that it is desirable and effective to grow churches by targeting homogenous groups of people—can lead to escapism, upward mobility, and suspicion of those who are different.   He adds that when churches put too much emphasis on providing stability and security to congregants, such stability and security “can become diabolical and idolatrous.”  He complains that when people choose churches that they think will best meet their needs they are following a consumerist mindset.  He asserts that “the church must resist treating members as though there are potential customers, selling impersonal religious commodities and commodifying relationships.”  Metzger believes that focusing on the Lord’s Supper will facilitate such resistance and motivate ministries of relocation, reconciliation, and redistribution.  I particularly like the following quote:

“That the whole Christ (totus Christus) is present to each assembly in every location where the celebration of the Lord’s Supper bears witness should awaken each assembly to be concerned for the total church in a given region, not just for those physically present.  It also suggests that these churches should work together for the common good of Christ’s kingdom in that region.”

What can churches do in concert with each other that would reduce consumerism and commodification?  Metzger suggests that rich Christians recognize that they have something to receive as well as something to give to the poor, that all recognize they are both victim and victimizer, that affluent Christians redistribute their wealth, and that we give glory to God rather than take it for ourselves.  I don’t disagree with any of this program.  However, taking such steps would seem to first require both an awareness of how affluence can damage us and a commitment to a more just society.  I didn’t find Metzger particularly helpful at fostering that awareness and commitment.

I’ve written previously about self-presentation on social media sites.  Thus I was interested in a recent ABC News article describing a study linking Facebook use to depression.  Heavier Facebook users were found to be more likely to report being unhappy.  They were also more likely to think others are happier and have better lives than they do.  Why might there be a connection?  The article suggests that it’s because the photos posted by other Facebook users are much more likely to be smiling and cheerful rather than frowning and glum.  Thus, frequent Facebook visitors are presented with an endless parade of grinning faces, and conclude that everyone else is having a better time than they are.

I don’t have access to the original article, and thus don’t have many details about the methodology employed, but I wonder whether the above explanation is warranted.  Isn’t it equally plausible that depression causes rather than is caused by excessive Facebook use?  Couldn’t it be that people who start off by suspecting that everyone else has a better life than they do are drawn to Facebook as a way to confirm those suspicions?

Whether Facebook use is cause or effect, the study does suggest that there are plenty of unhappy souls staring at computer screens, looking at pictures of smiling people.  Maybe we need to give such viewers a lift by posting more pictures of ourselves frowning or scowling.  Why, though, are so many of us posting smiling pictures of ourselves?  It isn’t because we’re actually smiling all the time.  There’s quite a bit of impression-management that takes place on the typical Facebook wall, so that what is seen by others is a carefully calculated fiction.    In his book The Church of Facebook, Jesse Rice describes what is happening as follows: “Fear is very much part of the climate of Facebook.  When we are afraid of what people think of us, we work hard to craft just the right image composed of just the right pictures, personal information, and status updates.  We position and reposition the spotlights on our Facebook portraits to reflect our most interesting side.  The emphasis is on being clever, not on being genuine.”  (as quoted in Christian Reflection: Virtual Lives, p. 38) We want to make a favorable impression, and are hiding our real selves behind well-burnished personae.  Others don’t know us, and we don’t know ourselves.

Are online self-presentations inevitably inflated and fraudulent?  Couldn’t we instead strive to be authentic?  A recent post by Cathleen Falsani on the God’s Politics blog describes authentic relationships occurring via social media.  She had used Facebook only for entertainment and casual social interaction until a day in April, 2008, when she read a status update reporting the death of Mark, a friend.  She and dozens of others who knew Mark shared stories and pictures about him.  A thread was started, one that still continues.  Falsani writes:

“If you had told me a few years ago that I would find community — real, authentic, deeply connected, deeply faithful community — online, I would have scoffed. I’m not, by nature, a joiner.  And yet, here we are, almost four years of daily interaction later, with a communion of 20 souls around the world. Since we formed this unlikely community online, we’ve walked with each other through sickness and pregnancies, the death of parents and siblings, job losses and career changes, one-and-a-half presidential elections, recession and war, adoptions, divorces and even a marriage between two friends who met through the thread.”

The bonds she developed as a result of daily online communication were so strong that, a few years in, she and her family moved from Chicago to Laguna Beach, California so they could regularly interact in person with several other members of the group.  Facebook need not be an avenue for concealment and dissimulation; Falsani found genuine fellowship there, and her experience suggests that the rest of us can do the same.

I recently saw the movie The Social Network, based loosely on the founding of Facebook.  The story is an ironic one: as screenwriter Aaron Sorkin put it in The New Yorker, “It’s a group of, in one way or another, socially dysfunctional people who created the world’s great social-networking site.”  The movie isn’t intended as a factual account; it is based on known facts, but is a dramatic retelling. 

We first meet Mark Zuckerberg (played by Jesse Eisenberg), Facebook’s creator, as a 19-year-old Harvard sophomore talking with his then-girlfriend Erica.  He alternately seeks to impress her with his knowledge, yearns for membership in one of Harvard’s final clubs, and shows barely concealed distain towards her.  She breaks up with him, not for his being a geek, she says, but “for being an a–hole.”  Hurt, he goes to his dorm room, gets drunk, writes a nasty blog entry about her, and hacks into the Harvard computer system to create a website inviting Harvard males to rate the comparative attractiveness of Harvard coeds.  The overwhelming response to the site crashes the Harvard server by 4 the next morning.  Mark, it seems, is insensitive, desirous of social acceptance, vengeful, and terribly capable. 

Mark’s escapade with the coed ranking site attracts the attention of Harvard seniors and identical twins Tyler and Cameron Winklevoss (both played by Armie Hammer), who are members of the social elite that Mark aspires to.  They ask Mark to join them in creating a social networking site for Harvard students.  He agrees, then strings them along while he creates his own site (initially called thefacebook) with the financial assistance of his closest friend, Eduardo Saverin (played by Andrew Garfield).  The twins soon learn of the betrayal and, after their attempts to resolve their complaint with Mark and the Harvard authorities fail, they sue.  Eventually, Mark, having fallen under the influence of Napster founder Sean Parker (Justin Timberlake), betrays Eduardo by diluting Eduardo’s shares in the corporation down to almost nothing, and he sues as well.  Much of the movie cuts from the principals and their lawyers sitting in depositions for these lawsuits to the actions being described in the depositions.  The social relationships of these social network builders are irreparably broken.  Mark seems incapable of establishing a meaningful emotional connection with anyone.

The movie suggests that Mark’s main motivation is acceptance by the social elite, especially by members of the final clubs.  As the fledgling Facebook starts to grow, Eduardo but not Mark is selected for possible membership by one of the final clubs.  Mark professes indifference to Eduardo’s acceptance, but there is a strong suggestion that Mark betrays Eduardo over envy.  What makes the movie so dispiriting is that Mark is driven by desire for something without value.  The members of the club to which he aspires are arrogant, condescending towards nonmembers, misogynist, and hedonistic.  Augustine wrote that we are defined by our loves, and that happiness is only possible if the object of our love is conducive to enhancing our well-being.  Even had Mark been accepted in the social circles he aspired to, it seems unlikely that he could have been happy.

I wrote earlier about the modern malaise of loneliness.  I suggested at that time that social networking sites provide only a thin veneer of community and may intensify loneliness.  Similarly, in a Newsweek review of Social Network, Jeremy McCarter suggests “A site that began as a response to modern loneliness looks, after the film, like a record of our own struggle with that condition.”  Our Facebook connections are superficial largely because we have a narcissistic turn when we sign on; that is, we tend to portray ourselves as more clever and important than we are, and we look to others for affirmation of that inflated self.  As portrayed in the film, Mark Zuckerberg certainly is somewhat narcissistic, and we become more like him when we enter his creation.  Narcissism is only part of the story, though. The Zuckerberg of the film has narcissistic elements, but I view him as being more autistic than narcissistic.  I’m not referring to the psychiatric diagnosis of autism but to the original meaning of the term.  My 1966 edition of the American College Dictionary defines autism as “fantasy; introverted thought; daydreaming; marked subjectivity of interpretation.”  Though he wanted acceptance, in the film Mark always took an inward turn; how he imagined the world and recreated it in his mind and in cyberspace was more important to him than how others actually viewed him.  Might not Facebook be autistic in the same sense: each of us creating our own fantasy, each pleased with the world we have made?

The freshman experience course at Methodist University, for which I was an instructor this past fall, has incoming students read a book “deliberately chosen for its thought-provoking potential.”   This year, we read Tracy Kidder’s Mountains Beyond Mountains, which is an account of the work of Dr. Paul Farmer and his organization Partners in Health (PIH).  Dr. Farmer, a physician specializing in infectious diseases and a medical anthropologist, has dedicated his career to working with the poor in Haiti and elsewhere.  Farmer and his associates have established effective community health programs in the central plateau of Haiti and have pioneered effective treatment of multiple drug-resistant TB in impoverished communities worldwide.  My students were impressed by, Dr. Farmer, seeing him as a good guy who does good things for others, though they tired of Kidder’s fairly lengthy and complex account of Farmer’s activities.  I think Kidder intended not so much to catalogue accomplishments as to examine the sort of character traits and ways of thinking that led Farmer to devote himself so tirelessly to the needs of others.  As such, I found the book fascinating.

Early on, one of Farmer’s patients told Kidder, “That guy’s a fuckin’ saint.”  When asked about the comment, Farmer disagreed, and then reflected, “People call me a saint and I think, I have to work harder.  Because a saint would be a great thing to be.”  In light of Farmer’s multitudinous works of mercy, his refusal to benefit financially from his talents, and the immense personal sacrifices he makes for the sake of his work, it seems he is being overly modest about his more-than-obvious virtues.   Farmer, however, is more acutely aware of the ways in which he has failed than the ways in which he has succeeded.   One incident is quite telling in this regard.  About a month after his daughter was born, Farmer treated a pregnant Haitian woman with eclampsia.  The woman’s baby was alive when Farmer induced labor, but was dead by the time it was born.  Farmer started crying, and realized that he wasn’t just crying for the stillborn infant but because he had imagined his daughter in that child’s place.  He later told Kidder, “It was a failure of empathy, the inability to love other children as much as yours.”  Kidder replied that it is only natural to love one’s own child more, but Farmer will have none of it: “All the great religious traditions of the world say, Love thy neighbor as thyself.  My answer is, ‘I’m sorry, I can’t but I’m gonna keep on trying.”  It seems to me he is succeeding far more than he realizes.

Another thing that struck me about Farmer was his absolute devotion to the welfare of each and every patient he treats.  An early example is his interaction with Joe, the patient mentioned above who called him a saint.  Farmer was asked to consult regarding the possibility of TB.  Besides addressing that issue, Farmer talked at length to Joe, a homeless substance abuser, gaining his trust.  Farmer visited Joe several times, arranged for his transfer to a homeless shelter, and even brought him a six-pack for Christmas.  This is not the behavior we expect of physicians!   Kidder also provides numerous examples of Farmer’s devotion to the well-being of needy Haitians regardless of whether his interventions constitute conventional medical practice.  A blind man wanted glasses; Farmer found him a pair.  A woman believed that one son’s death was due to sorcery by her other son; Farmer explained at length why sorcery couldn’t have been involved.  He held the hand of an AIDS patient whom no one else would touch, ordered nutritional supplements for the malnourished, bowed low to receive kisses from an elderly woman bent double with Potts disease, bantered with a group of recovering TB patients, and, after retiring for the night, returned to the clinic to care for a newly arrived adolescent with meningitis.  As a health care provider myself (though for emotional, not physical, ailments) I am inspired by him but also fall far short of the dedication he has to his patients. 

I’m also struck by the extravagance with which Farmer and PIH invest resources in the poor.  Near the end of the book, Kidder describes the case of John, a Haitian teen who had a rare childhood cancer.  His only hope for survival was to be brought to Boston for treatment, but he was too sick to take a commercial flight.  There was a good chance that the cancer had metastasized, in which case nothing could be done, but that couldn’t be determined in Haiti.  With Farmer’s approval, the attending PIH physician arranged for a medivac flight costing nearly $20,000.  Unfortunately, when John reached Boston, specialists determined that the cancer had indeed metastasized, and John soon died.  Kidder later asked Farmer whether the money spent on John could have been better spent on other patients—essentially, whether the PIH approach was cost-effective.  Farmer’s answer was drawn from liberation theology:  God has a preferential option for the poor and that his followers should show the same preference (in brief, living out this “O for the P” philosophy is Farmer’s life goal).  Farmer elaborated:

“If we could identify losers like John, and not waste our time and energy on them, then we’d be all good, as they stay in the States.  Right?  But the point of O for the P is that you never do that.  You never risk that.  Because before you turn your back on someone like John you have to be really really sure. . . . Shit, man, how can you be an O for the P doc and be willing to take that risk without all the data you can get?”

Such extravagant care consistently violates principles of cost-efficiency.  Farmer treated poor AIDS patients in Haiti with antiretroviral drugs before that was being done anywhere else, and treated poor Peruvians and Russian convicts who had multiple drug-resistant TB with expensive second-line drugs when conventional wisdom was to stop after first-line treatment.   He often leaves his busy clinic in Cange, Haiti to hike into the mountains in search of a patient who hasn’t come for follow-up care.  A day spent finding a single patient is a lavish expenditure of medical talent.  Farmer’s hikes remind me of Christ’s parable of the shepherd who left 99 sheep to search for a single one who had wandered off.  Medical care is seldom provided with such devotion to each patient’s welfare.  Still, the good shepherd may be an apt model for how a saint would practice medicine.

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