Gordon Cosby is the man partly responsible for my 30-year career as a healthcare chaplain. Few outside a certain circle have ever heard about him or the congregation he co-founded with his wife, Mary, the Church of the Saviour (CofS). But there is a rather wide circle of folks who owe much of who we are to Gordon and Mary.
I left a thriving church youth ministry in Macon, Georgia in 1978 and moved my family to Washington, DC, just so I could be part of what he and Mary started. What they had done drew scores, if not hundreds, to leave home, jobs, and traditional churches behind. So we sold a home in Macon and put all our worldly belongings in a Ryder truck and moved here with our two kids. I worked as a carpenter for a year then for four years directed one of CofS’s ministries trying to create jobs for hard-to-employ people.
Gordon preceded me at the Southern Baptist Theological Seminary in Louisville by maybe 35 years. He served as an army chaplain with a combat unit in the Second World War. Convinced there was a better way to do church he and Mary started a congregation with just a handful people. The guiding principles were few: integrity of membership, commitment to mission, and commitment to prayer and the inner spiritual life.
By 1983, the job with the inner-city ministry was coming to an end and I was facing a time of unemployment. Gordon was approached by Charmaine and Robert Bainum, owners of Fairfax Nursing Center (Virginia), asking him if he could suggest someone to serve as chaplain at their nursing home. Robert knew Gordon through their joint concern for Cambodian refuges in Thailand. Gordon suggested me. I interviewed and got the half-time position. I don’t know if they interviewed anyone else. . . . Gordon was just that respected.
I knew precious little about healthcare. It was on-the-job training. I was ten years out of seminary and out of work. I thought I would give it a try. It turned into being a real call. After six months at half-time I asked if we could make it a full-time position. Turned out I liked it that much. They said yes and I was at the nursing center until 1996 when I moved over to hospice.
“Call.” It’s a big word around Church of the Saviour. It wasn’t so mysterious. What is my passion? What do I really care about? If you could find another person who shared your passion you could announce a call to start a new mission group. I witnessed the birth of many missions to serve the poor in Washington and around the world. Common folk who felt called stepped up to live out that call.
My call to healthcare chaplaincy followed my actually being hired to do the work. Details. But call it has turned out to be. It has been a passion that has broadened to helping all the deaths in this country to be more compassionate. When I introduced my second book, Light in the Shadows, to my colleagues at hospice in 1999, one of social workers commented, “Hank, you really have found your niche.” My immediate response was, “No. My niche found me.”
Sometimes call works that way.
As I sought ways to minister to severely demented patients on our Alzheimer’s unit I am sure Gordon’s influence was with me. He was the embodiment of servant leadership. In the early days of the jobs program at CofS, I worked with a housekeeping crew that cleaned apartments to prepare them to rent. Gordon came to visit us one day at a work site. He found me on my knees cleaning up the filth around a toilet. He laughed and commented, “Bet they never told you about this part of ministry at the Southern Baptist Seminary!” Indeed they didn’t, but I saw Gordon set tables at the Potter’s House coffee house or sit with a drug addict who was sorting out his life.
How could I “reach” the demented nursing home patient? Bible studies didn’t work and they couldn’t track my sermons at chapel. I found playing my guitar and singing the old gospel songs connected. I wasn’t very good but they didn’t seem to care. I also learned to hand feed patients. I would show up on the dementia unit at lunch time and tell the nurse, “I could help feed some people but I don’t want any spitters or chokers.” I am reminded of Jesus words, “Whenever you have done it to the least of these you have done it unto me.” Gordon lived those words.
Jim Wallis of Sojourners wrote, “Gordon Cosby taught us how to live by the Gospel and, in these last years and months, he also showed us how to die. In one of my many visits near the end of his life, Gordon said to me in his deep graveling voice, ‘I am enjoying dying.’ What a Gospel thing to say.”
How would my life have been different if Gordon had not given my name to the Bainums? I may have found my way to the bedsides of the dying. I don’t know. Don’t have to. He did and here I am thirty years later. Thanks Gordon.
What five things can physician groups agree will not help and may harm patients?
This is the question posed to physician professional organizations in an effort to help patients avoid harm. Twenty-six medical groups, from the American Academy of Allergy, Asthma & Immunology to The Society of Thoracic Surgeons, polled their members and came up with a list for each specialty. Interestingly, two different groups listed the same treatment at the top of what is to be avoided. These lists were just published last month.
Both the American Geriatrics Society and American Academy of Hospice and Palliative Medicine ranked feeding tubes in advanced dementia patients as the number one treatment to avoid. Specifically, number one of both lists is, “Don’t recommend percutaneous [through the skin] feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding.”
I have blogged about this before. The research is clear. For patients with advanced dementia, like end-stage Alzheimer’s, feeding tubes offer no benefits and increase the burden of living.
Often, these patients have increased difficulty eating as the disease progresses. The quantity of food they take in declines and they lose weight. They can choke and get food in their lungs that can possibly turn into aspiration pneumonia. These problems are common at the end of a long decline in this sad disease process.
Mistakenly, some medical professionals recommend a feeding tube when these expected eating difficulties arise. They might say, “Your mom is having eating difficulties and we are worried that she is going to lose weight and maybe get pneumonia. We recommend putting in a feeding tube to prevent these things from happening.” THIS IS NOT TRUE! They may even say, “You can’t let your mother starve to death. Let us put in the feeding tube.” DON’T BELIEVE THEM! There is nothing in medical research to back up what they are telling you.
I want to emphasize that what I am talking about here applies to dementia patients. Feeding tubes may be very helpful to others like some stroke patients or survivors of throat cancer. Consult with your physician to see if this research on advanced dementia and feeding tubes applies to your case.
Tube-fed advanced dementia patients do not live longer than carefully hand-fed patients. I used to tell families that putting in the feeding tube only prolonged the dying process. I WAS WRONG! In one study a group of surgeons assessed 41 advanced dementia patients who were experiencing eating difficulties. All 41 met the criteria that have, in the past, led to a recommendation for the insertion of a feeding tube. The tube was refused by 18 families. Both groups (tube-fed and hand-fed), on average, died within about the same amount of time. Putting in a feeding tube did not add one day to the life of these patients but made them more uncomfortable and actually might have caused them harm.
Tube feeding does not reduce the risk of aspiration pneumonia. In fact, some studies show that it increases the risk. These patients can be fed orally with careful hand feeding. It takes skill, time, and patience, but it can be done.
Interestingly, there is a wide difference in this country in the frequency of use of feeding tubes for severely demented patients. On average, 21% of advanced dementia patients in the United States have a feeding tube. But look at the different rates of use:
On the low side:
- Wyoming only 4% use.
- Montana, New Hampshire, and Maine all have 5% use.
On the high side:
- Alabama has 34% use of feeding tubes for advanced dementia patients.
- Hawaii has 36%.
- The District of Columbia has 45% use.
How do you explain such wide use of a treatment known to offer no benefits and cause harm to the patients who get them? I say these tubes are put in for cultural, emotional, and spiritual reasons. It cannot be for medical reasons. In places where use of feeding tubes is high you may be going against the cultural norms to refuse the feeding tube. Hopefully, we can get the word out there to be compassionate to these patients in their last months and feed them by hand.Hank Dunn