08.21.15

calvary

Posted in Uncategorized at 6:25 pm by Administrator

sometimes, i am so struck by the story of the Gospel.

today, i am struck by the idea that Christ could have chosen any number of ways to experience His people. but He chose a life with them that ended with that lonely, humiliating, and excruciating path up Calvary Hill. we don’t know what He was thinking as He listened to us, the indignant mockers who lined up along His journey to scorn Him. but we know that He chose that particular life and death, despite all the ways of life He could have had. and because He ascended that hill as an innocent man, and because He chose to suffer to the point of His own death, i can see now the difference between Him and me. my people pushed a good man to a terrible and unjust death. He did what He did out of simple compassion and profound love.

i cried thinking of that today. how many times have i imagined my Lord walking that lonely road? and yet, every time it is new. though i never see His face as He trudges toward His death, i hear His voice, and even now He tells me these are not your people, not anymore. come with me, and go with me to where i am going

08.20.15

The 7 Things I Need to Do

Posted in Uncategorized at 7:46 pm by Administrator

every now and then, perhaps once or twice a year, i fall into a very particular state of mind in which i’m capable of taking stock of every single thing going in my life. in one sense, it’s a moment of incredible derealization, when i’m able to pull out of everything that i am and look at how i’m changing. in another sense, it’s a moment of intense engagement with my self, in which i am truly connecting with the person that i am underneath all the responsibilities, roles, and lines of thinking.

these tend to be moments when i recognize that i’m making up everything as i go along. faith in God. faith in my longevity. faith in the importance and value of the things that i spend my time and energies on. like john koethe suggests in his masterful poem “Falling Water”, i become to myself simply a “state of mind” in these moments; and i realize that i am a willing participant in a grand experiment of conformation to an entirely speculative set of collective beliefs. to put it simply, in these moments, i realize that i do not know what is true—nor do i care. if God is not real, it does not really matter. if i am already and even now dying of a terminal disease within my bowels, it might matter for a time, and it may disrupt the exquisitely fragile illusion of life that i have chosen to accept, but this ultimately will not matter so much either. i am a state of mind… and the things i have taken to be true are simply the walls and the halls i have constructed for my time on earth, so that i might traverse my path and look back upon my steps with the idea that i actually went somewhere.

and here too is a truth that i think i intuitively grasp in these moments. God, if He is real, does not care whether i take His existence as a fact. it is enough for Him that He has become a part of the fabric of my existence, the walls that border my hallways, the paver stones that mark my progress—or at least my passing. in times like this, i can sense that the God i have read into the lines of scripture and everything between those lines is not concerned about what i am willing to die for. He is more interested in what i do in this life with the little i understand and take to be true. He is interested in the fruit that comes out of my uncertain premises, that shifting, crumbling patch of soil within which a seed, a particular seed, was once planted.

in any case, here at the precipice of the dark cliff from which i view the oddly small and strange landscape of my possessions and priorities, i can recognize that there are seven things i so wish for. those wishes are submerged beneath other wishes and reflections and memories, but they are there nevertheless. they are like fault lines beneath the earth that i survey; they are the large rocks upon which the smaller rocks and soil reside to form the illusion of a seamless tapestry. in truth, my life is segmented upon these desires that run deeply, and these edges are jagged edges that run deep to the core of what i am. it is left to me now to understand just how deeply these chasms run. it is left to me to know myself through them.

1. i wish that my Dad were well. just for a brief time, i wish that i could see him well, in his body, mind, and spirit. i have never seen him well. i have wanted to see him well for so long that the wish, however subconscious and remote it has become, drives my inner workings and fuels my sadness—that great sadness which defines what i am.

2. i wish i could connect with my closest friends and appreciate them in a way that can be both sufficient and enduring. there are a choice few friends in my life that i have genuinely loved over the years, and our paths do not frequently intersect and may never run together ever again. that is all right with me… but i wish i could have one moment with each—a moment deep enough and sufficient enough to validate our friendships for a lifetime. i think of Andrew. i think of the McErleane family. i think of Won Ho, Yemi, Chris, and Chris. there are others too.

3. i wish that i could deeply affirm my children and give them the best of what i have learned in my life.

4. i wish i could lead the leaders in my life, in a manner that gives them joy, and in a direction that helps them to be truly and meaningfully effective.

5. i wish i could dream with someone. and there are very specific people that i think i could do that dreaming with. they are the ones who bring their conviction, wisdom, and focus to the relationship; and to them, i bring my intuition and ambition. i was designed to facilitate the hopes and aspirations of others. and so part of this wish is to find those singular partners, in all the various arenas where i do my work.

6. i wish that i could understand my personal needs within community. i know that i do not need many friends. but i know that i have to be connected to people—groups of people—in order to express what i am. i want to know what i need so specifically that i can even plan for my “retirement”—that time when i am no longer defined primarily by my responsibilities to my people.

7. i wish that i could stay in a place of intimacy with my wife. i think that something in me grieves at all times because i am incapable of remaining in a state of intimacy with anyone but particularly with my own wife. and the enneagram has helped me to understand why this is. i am not lonely even when i am alone, and so it is hard for me to grasp the value of intimacy. but because it is so horrifying to me, i sense that genuine intimacy must be precious. i want to experience that in my life, even if it is for just a season. i want to be all-in, in a manner that teaches me the transforming experience of love. i want to be able to say that i gave myself over to it, even though it killed what i was. i want that, for happiness—whatever happiness proves to be

08.15.15

on listening

Posted in Uncategorized at 4:33 pm by Administrator

tomorrow, i have to give a talk to one hundred five Latino scholarship winners as well as several dozen of the most prominent Latino political and industry leaders in my region. because my CEO was supposed to give this talk but had to back out five days ago, the buck was passed to me, and i still don’t know exactly what i’m going to say. i have ten minutes to talk about anything. it is possible that i will elect to totally wing it tomorrow. it is entirely possible that i will talk extemporaneously. because in the moment, i am capable of absolutely anything.

but just in case i cannot come up with anything else between now and 13 hours from now when i’m at the podium of the JW Marriott conference room, i’m going to write out something right now about listening. because once upon a time, i thought that the point of an education was to learn how to teach others; but now i’ve realized that the point of an education is to learn how to listen.

i’m an HIV doctor. there’s a whole story behind that, about how i once wanted to be a missionary doctor in Africa, about how i wanted to cure a deadly virus, about how i wanted to fight prejudice and disease in my society. it suffices to say that i didn’t simply become an HIV doctor because i wanted to help people; i wanted to save lives and change society in the process. and that motivation led me to the company where i currently work—a community health center that serves a predominantly Latino population, many of whom are undocumented immigrants. i’m proud of the company i work for. in fact, i love my company. i love its vision. i think it captures real excellence—compassionate, visionary, and medical excellence.

oddly enough though, i’ve learned over the past five years i’ve been with the company that my organization is made up of a lot of leaders and doctors and patient advocates who want to be absolutely sure that we’re undeniably excellent at what we do. yes, we’re the biggest federally qualified healthcare center in the country. yes, we’ve quadrupled our operating budget over the past five years and are growing in size and patient enrollment faster than virtually everyone else in our market. but when our stakeholders, our board, and our senior leaders sit at the table, we ask ourselves, “are we really excellent? and if we are, then how are we proving that?” and those are personal questions to us, because our work is personal work. in our clinics, we’re taking care of our parents, our friends, our own people. and because of that, there isn’t a single number or a metric to describe our performance that’s powerful enough to tell us if we’ve really made it—if we’re really excellent now.

it’s for this reason that about four years ago, my company decided to start pursuing the biggest performance excellence award out there, for companies across any number of industries. it’s called the Malcolm Baldrige National Quality Award, and it’s reserved for the best of the best companies in America. and the reason the Baldrige Award is so unique and so compelling is that it actually defines what excellence is. its criteria force every organization that applies for the award to understand and to apply its specific idea of what excellence is. and over the past four decades, that idea of excellence has resonated so much with so many people of influence that it has veritably become an international definition for organizational performance excellence.

i’ll bet that you want to know what that definition of excellence is, don’t you? i mean, i’ve talked so much about excellence and how difficult it is to define it that you must be so curious how the Baldrige criteria define excellence.

but before i get to that, i’m going to tell you how i got interested in this. there were three of us doctors that joined my company’s HIV services division around the same time. we were all really similar—recently done with training, basically in our first jobs, highly educated, and interested in international work and HIV science. we started out gung-ho and having a lot of fun together. we saw great cases; we brought a lot of sick people back to health; we became friends with our patients and our staff.

but something happened to us over those first two years of practice together. we each started to burn out. it was tough seeing sick people every day. it was really hard seeing how our gay and transgender patients were struggling in the world outside our walls. it was really stressful handling the complications of heroin and meth addiction every day. each of us dealt with that fatigue in different ways. but here and there, i think we really broke down. it struck me, as we began to disconnect from our patients and from one another, that in a way primary care medicine is an experience that can really injure those who are responsible for doing the healing. and so i began to develop a passion not only for healing patients but also for supporting and restoring the doctors at the front lines—the wounded healers. that’s when i started speaking up for the doctors and for the staff at my company. and that’s when i got interested in changing our systems and our culture so that we can protect and sustain the people who do the hard work at the front lines.

i jumped into my company’s efforts to learn about the Baldrige Award because i had to believe that excellence, at least in some small part, had to be about keeping me and my colleagues well—not just well enough to do our jobs, but also well enough to keep us getting better and better at what we do.

for three years now, i’ve been a Baldrige examiner. i’ve attended national trainings; i’ve read the Baldrige criteria from cover to cover; i’ve examined and audited other companies trying to win the Baldrige Award. and i’ve learned that for me at least, the Baldrige idea of excellence can be summarized in two statements; 1) it’s not excellence unless it’s excellent to everyone involved, from the corporate leader all the way down to the front-line employee and the first-time customer sitting across from him; and 2) you won’t know if it’s excellent to everyone involved unless you listen. it starts with listening. and if you can’t listen to everyone involved in a great enterprise, you’ll just never know if that enterprise is achieving excellence.

now, this lesson is nothing new. great business researchers and teachers and even religious figures have learned this important lesson and tried to teach it to us, from Jim Collins in “Good to Great” to James Hunter in “The Servant” and even Jesus Christ in the Bible. they’ve all emphasized the same theme over and over again: that the great leaders that drive their teams to excellence aren’t the confident know-it-alls. no, they’re the humble men and women who totally devote themselves to listening to others: listening with empathy, listening with intention, and listening so that they can learn, keep learning, and understand people and their values on the deepest possible level. but it’s hard to put this lesson into practice, isn’t it? as a doctor, i was taught to always know the answer and never show doubt. all of you i’m sure have already learned in school and in college about great leaders who were confident in battle, knowledgeable in the court room, and decisive in times of political crisis. and so it’s oddly surprising, i think, to confront the fact that our best research and our most thoughtful standards of excellence really say that the ability to listen—truly listen—is more important than knowledge, intuition, confidence, good looks, and charisma put together.

my company has taken this lesson to heart. we’ve learned over the past decade or so that the more we listen, the more we realize that our patients and our employees want us to keep growing, to keep changing, to keep trying to be the best. gone are those days when our community thought it was good enough to simply have a clinic that would see patients regardless of whether they were insured, whether they were rich or poor. they want easy parking; they want bike racks; they want to access their test results on-line; they want bilingual doctors; and they want appointments quickly, and they don’t want to wait 2 hours to get in with the doctor. and just as importantly, they want to get care at an organization that listens to them—a team of healthcare providers that listens to them. and so we listened to that. we developed an electronic portal so that our patients could talk to us on-line and get their test results with the push of a button. we bought new survey tools to reach more of our patients through the internet, by phone, and at their homes. we’ve done leadership 360 surveys so that our leaders can learn from their staff about how well they’re communicating. we’ve hired consultants to study our leaders, and we’ve hired consultants to study our consultants. we’re a veritable university of leadership now. we take our listening so seriously that we actually ask our patients on our surveys not just how highly they rate their doctor but we ask them specifically “did your doctor listen carefully to your concerns?” we ask our employees “do your managers and leaders listen closely to your feedback?” we ask our board members, particularly the old ones, “when is the last time you got your hearing checked?”

all of my work with my company and with the national baldrige program hasn’t just changed the way i look at big companies. it’s also changed the way that i look at my day to day work. it’s changed the way that i look at my relationships. and i want to finish up my talk with a story about listening and about excellence that has to do with a patient of mine, whom i’m going to refer to as Bob. i first met Bob five years ago when i first started at the hiv clinic at my company. bob was a young Mexican-American man in his mid-30s, a nice guy—he always apologized for taking up my time, for not taking his medications exactly as they were prescribed. when he was hospitalized for complications of AIDS, which was frequent because he wasn’t doing well at all, he would apologize for having let me down. month after month, i kept hearing bob tell me this and that reason for why he couldn’t remember to take his pills, or why he couldn’t keep his appointments with me. and so i kept telling Bob the things that i thought were most important: Bob, if you take your pills, we can save you from AIDS. you can actually live a long and normal life, as long as anyone else, and you won’t have to feel sick all the time. Bob, you have to try. Bob, you have to listen to science!

after two years of working with Bob and seeing him get sicker and sicker, i got frustrated. i was so frustrated in fact that i told Bob i didn’t know what to do for him anymore. i told him, “Bob, i’m trying to treat your depression, your HIV disease, and your recurrent pneumonias. you’re not letting me do my job for you. i have to ask you, bob. what is it that you want?” and Bob looked at me and said, “Doc, that’s the first time you’ve asked me what it is that i want.” and then he said, “all i want is to stop being afraid. and every time i come here, i’m afraid. every day i’m living at home taking these meds, i’m afraid. i don’t want to be afraid anymore.”

and i asked him again, “Bob, what do you want. and how can i help you?” i was listening now. really listening. i was trying to empathize. i realized Bob needed me to see his life the way he saw it. and Bob told me, “i don’t want to die in a hospital. i want to die at home. and i don’t want to take pills anymore.”

i saw Bob three more times. we had him sit down with our psychiatrist, our social worker, and our mental health counselors. and when we had all had a chance to talk to him, to listen to him, and to understand what Bob wanted together, we were able to let him go. two nights after he went home under a home hospice program, he died in his sleep. his mom came and found me in the clinic two days after he passed away. she told me, “Bob died the way he wanted to die. he had no pain. you know, for all those years he came here, he always told me that no one ever really listened to him. but in the end, he felt heard. and i’m so thankful that you listened.”

and despite my grieving for Bob—because at the time of his death, Bob was a friend to me—i could realize in that moment that the way Bob had died, on his own terms and with his family, was a good thing. and because it was good to Bob and to everyone that had cared for him, it was excellent, even though it was death.

i want to tell you all here that when you listen, you will not always hear what you want to hear. when you listen, you will find more questions than answers. when you really listen to the people you serve and the people you need, you will hear difficult, difficult things that will hurt you and make you change. but i promise you this: if you learn to listen, and to keep listening until you’ve heard the thing that challenges you to your core, the achievement of excellence will always be possible for you. and i hope that for the rest of your lives, you will pursue what is excellent.

08.10.15

it matters. and it doesn’t matter

Posted in Uncategorized at 8:37 pm by Administrator

recently, i’ve had some time to reflect on what i’ve become and what i’m becoming. this wasn’t casual reflection by any means. it was a real, profound, and personal wrestling with myself. in this season of my life, i’ve been stretched by tension and conflict within my extended family, within my church, within my place of work, and within my nation as well. and while i enjoy conflict to some degree, i don’t want to be defined by my differences with others. when i am immersed in so much disagreement with others, i begin to feel lost in a way. i begin to feel fundamentally alienated.

recently, i’ve been going to God with a lot of these unsettled and even anguished feelings. i find myself asking Him if i can’t just give it up—my positions, my ideas, my beliefs. do they really matter? does it really change anyone if i stick up for an unpopular position, or if i advocate for the silent minority, or if i assert my differences with others in any of a variety of conversations? here and there, i wonder if i shouldn’t emulate the people of quiet wisdom that i so admire, the people who listen more and speak less. i wonder if i shouldn’t be more quiet and more discerning.

on matters of race and sexual orientation for instance, must i be so outspoken when i feel offended or jarred by the tone or the terms of conversation? must i be so sensitive about the way things are said, particularly when i can acknowledge the good intentions of the people who are saying those things? must i buy into the feelings and rhetoric of a society so charged and impassioned on these matters, especially when i can see that these feelings and this rhetoric arise from agendas that are not always transparent or just? maybe, in the end, my beliefs on these matters don’t matter.

i was at something of a retreat this past weekend, and i was asking God to help me understand the folly of my self-inflicted tension and bewilderment. just tell me it doesn’t matter, and i will be quiet, i said. tell me it doesn’t matter, because i know that in the face of eternity, none of it ought to matter at all.

and i felt God tell me this. it matters, He said. it matters when you speak. it matters when you fight for someone. it matters when there’s prejudice and pain. and it matters that you care.

but when you stand before me, those things must not matter in the face of my will for you. you must be willing to give them up—even the things you cherish and hold most dear—for my sake. and because i will ask you to submit everything, even unto your death, none of it matters in the end, save your obedience to me.

to hear the Lord speak in this way reminded me of abraham, as he took his son isaac to the appointed place to put his son to death as a sacrifice unto God. did abraham truly believe that the Lord would ask him for the life of his son, the child who had been promised to him in his old age as a sign of God’s faithfulness to Him? should it not have been anathema to abraham, that the Lord might demand such a savage price for His favor, that God Himself could command such an act of cruelty? yet, abraham believed God, contrary to everything that the man felt and believed. when tested, he put his beliefs about what was right, wrong, good, and evil aside; even his deep love for his own son was something he set aside for the sake of God’s Word. obedience unto total self-sacrifice was the only thing that mattered in the end, when abraham stood before the Lord.

this is the standard placed before us, in this time of war, argument, division, and violence. all the “-isms” we can summon to define what we love and despise might reflect the best of ourselves—the most noble of our beliefs, the profoundest of our sympathies. but even these, in the end, are meaningless next to utter obedience to the Lord. and ultimately, unless we are willing to speak and act as those beholden to God and chained to His purpose, we express only the best in ourselves, which is neither truthful enough nor sufficient in the face of God’s limitless wisdom and love.

and thus i recognize that i am allowed (or even intended) to hold to my strong beliefs about justice and goodness, even to the point of provoking conflict or upsetting the peace. but like one who is holding onto a lifeline at all times, should my grip with one hand be challenged, i must be willing to drop whatever is in the other hand to take hold more tightly of the thing that saves my life. ideas, even the greatest of our causes, are things we can hold only as firmly as the salvation that sustains us. and so i submit that my great convictions and beliefs are all folly of a kind. i could die for those beliefs, and my death for those things would mean so little.

and so i acknowledge before you, oh Lord, that these things i believe both matter and don’t matter at all. shape my thoughts; let me conform to your Spirit; and every now and then, push me to surrender the things i hold most dear. teach me how to surrender those spaces and those conversations in which i fight with men; teach me how to depart from those spaces and from the man that i am in those places. though i belong to my family, to my race, and to my people, let me belong above all to you; let me belong to you so clearly and wonderfully that they might look upon me and know, at all times and beyond a shred of doubt, that i am yours

08.03.15

Evasion conversation

Posted in Uncategorized at 5:42 pm by Administrator

no one who reads my blog can mistake my stance on gay rights or how important that issue is to me. i think that there have been moments when i’ve had to check myself and my emotions and recognize where and when i cross the line. as outspoken as i have been on the matter of “heterosexual privilege” in our society, i know that i’ve interjected tension and conflict within the various communities that i dialogue with. here and there, i’ve felt God press me to examine myself and my motivations. do i press the issue for His glory? or have i provoked conflict because i enjoy attacking people? both, i think, have been true for me.

i think that the Lord has impressed upon me a few things of importance over the years. first of all, my gay friends and brothers do not need me to be their representative or advocate. they are capable of speaking up for themselves, and they have done so effectively. i’m sure they appreciate having hetero friends who support them; but they don’t need a hetero man to speak on their behalf. that’s the state of things in this society. gay people are not the “straight man’s burden”.

the Lord has also convinced me that my words are not as influential or important as the lives and personal experiences of LGBTQ people. i can talk, yell, or even campaign for change in my society; but ultimately, even the best of my words cannot match the power of what a gay man can do when he engages directly with people who judge him unfairly. i overestimate the significance of my beliefs and positions, and indeed i embarrass the cause that i embrace when i attack my opponents for the sake of belittling them. yes, i despise “Christians” who loathe gay people. to be frank, that is my problem—and my sin.

but God has given me some grace (and space) to express my sympathy for my friends who feel alienated in the church. and thus, i am most fruitful not when i combat my opponents in the public forum but rather when i show through my personal relationships that i value and love the LGBTQ people that God has placed in my life. and i am certainly not immune to the systematic prejudices which have injured that community. as i’ve written about many times, i still struggle with privilege, entitlement, and even prejudice on a basic level; and on a daily basis, these things affect my ability to show genuine compassion and concern for the people who come to my clinic in need of my help.

that being said, i think that the one thing that i feel the need to take issue with (not in anger, but in love) is the new mode of conversation within church around LGBTQ issues. i would describe that conversation as the “evasion conversation”. it is captured in statements such as “i think people talk about homosexuality WAY too much”, or “this issue is blown out of proportion”, or “society is hijacking the conversation on sex”, or “there’s another way to talk about these issues in a way that’s less divisive”. the evasion conversation represents the contemporary church’s efforts to deconstruct and redirect the moral conversations around sexuality. by borrowing from the methodology and philosophy of the postmodernists, Right-leaning Christians are now elaborating a new and more passive manner of resisting the evolving and increasingly “tolerant” cultural approach to LGBTQ issues. that form of passive aggression, more than outright prejudice against gays, is increasingly the face of privilege and oppression within the American church. it’s not so much a message of “you’re not welcome here” as much as one of “we don’t need to talk about your sexual deviancy problem”. and i believe that the latter message is one that is even more disabling and destructive than the former.

to be fair, i think that there might be some legitimacy to the general idea that the broader social conversations around LGBTQ issues are based on constructs that necessarily shape and narrow those conversations. some of those constructs are not highly compatible with the terms and approaches generally employed in Evangelical church settings. for instance, the social conversation emphasizes concepts such as acceptance, tolerance, human rights, and human entitlements; and these are terms which do not often inform conversations within the church about God’s approach to human suffering and redemption. in the biblical paradigm, people don’t find meaningful spiritual healing through social harmonization; rather, people find healing by first identifying themselves as fundamentally broken. therein lies a potent obstacle to any meaningful dialogue between the church and society about shame.

still, the onus is on the church to find ways to dialogue with the broader society and to be facile with society’s terms of engagement because it is the church’s work to connect with the lost and to demonstrate Christ’s compassion for them. thus, if a marginalized segment of our society chooses to express their issues and concerns in specific language, it is our responsibility to validate that language, understand its context, and translate the truth of Christ in those terms. this is precisely what the apostle Paul gets at when he suggests that the follower of Christ ought to be a “Jew to the Jews” and a “Gentile to the Gentiles”. it is the essence of what he states when he declares that “everything is permissible”, with regard to those basic matters of lifestyle and communication that too frequently distinguish the cultured from the uncultured, the righteous from the unrighteous, and the privileged from the powerless.

if the LGBTQ community and its proponents want to discuss sexual orientation and lifestyle in terms of prejudice and personal rights, they do so for reasons that are powerful and significant to them—and it does the cause of Christ no disservice to learn that language and speak it with sincerity in order to win their hearts for His purpose, which is love. when Christians refuse that dialogue because they disagree with its terms, its specifics, and its ramifications, then they demonstrate privilege of the most insidious kind; they profoundly invalidate the sentiments, purposes, and experiences of the community that has defined itself around those terms.

i encourage the believers of this generation to understand the “evasion conversation” for what it is. it is irresponsible, it is exclusionary, and it is profoundly unloving. it tells a gay man to his face that he does not properly understand his sexuality for what it really is. it tells the transgender person that the manner of her struggle is unnecessary or irrelevant. it tells the lesbian woman that she is overdramatizing the trauma she has experienced in her society. it tells all who struggle from prejudice and social marginalization that even their voices—the last shred of humanity left to them—are not worth dignifying. that is a cruelty beyond common cruelty. it is hatred, presented in the guise of intellectual sophistication, and it is prejudice, cloaked in high-minded meta-philosophy. and that face of the church—that is the ugliest face of the church i have ever witnessed in my entire life