Sunday, August 30, 2009

Universal Precautions

Here's this morning's homily, which was received especially warmly by a woman in our congregation who's a former ER manager. The readings are James 1:17-27 and Mark 7:1-8, 14-15, 21-23.

Postscript: Please see this post for clarification of audience issues.


As a hospital volunteer, I spend a lot of time washing my hands. Everyone in the hospital is supposed to wash their hands before and after contact with a patient. After eating or using the restroom, hands should be washed with soap and warm water for twenty seconds -- or as long as it takes to sing the Happy Birthday song -- and then dried with two sets of towels, which should also be used both to turn off the faucet and to turn the bathroom doorknob.

On other occasions, it’s acceptable to use the dispensers of hand cleanser placed outside every patient room. The cleanser comes in two varieties: a pungent goop reeking of rubbing alcohol, and a foam that looks like a cross between whipped cream and hair gel. I prefer the foam, although I often manage to squirt it not only into my palm, but onto my shirt and the floor.

Whatever method one uses, the goal is to cleanse every surface from fingertip to wrist, not neglecting the underside of the fingernails, which should extend no more than a quarter inch past the end of the finger. Nail polish is forbidden, as it might hide dirt.

Meanwhile, restrooms and elevators are festooned with signs advertising the benefits of washing your hands. Handwashing, often called “the universal precaution,” is the #1 method endorsed by the Centers for Disease Control to cut down the transmission of illness. But the signs display the somewhat grim statistic that although 92% of people claim that they always wash their hands when they should, observation has revealed that only 77% of us actually do.

A few years ago, new signs went up in the Emergency Room, where I volunteer. These signs proclaimed that ER staff weren’t washing their hands often enough, and would be monitored until they improved. Several weeks later, those signs were replaced by others saying we were all doing much better. Big Brother was watching.

This hypervigilance about handwashing is a direct consequence of the germ theory of disease. There’s a scientific reason why handwashing reduces the spread of illness. And indeed, since I began volunteering at the hospital -– where it’s not at all unusual for me to wash my hands twenty times an hour -– I’ve been sick much less often than I was before.

What, then, are we to make of Jesus in today’s Gospel? When the Pharisees complain that his disciples haven’t washed their hands before eating, he doesn’t scold his followers and send them to the nearest bar of soap. Instead, he scolds the Pharisees, telling them that they’re hypocrites. Dirty hands don’t defile people, he tells the Pharisees. Dirty hearts do.

This horrifies those of us brought up on germ theory. Jesus! we want to say. Do you want your disciples to get colds or the flu? What about smallpox, chickenpox, or pinkeye? Jesus, please: we love you, but you don’t live in the most sanitary of surroundings. Sure, we know you can heal people, but wouldn’t it be better if they didn’t get sick in the first place? You’re great about washing people’s feet, but their hands are important too!

This is where historical context comes in. Jesus and the Pharisees lived centuries before the discovery of germs. While the Jewish purity laws undoubtedly helped prevent illness, that’s not why the Pharisees are upset in this Gospel. They believe that those who don’t clean their hands also haven’t cleaned their hearts, that outward impurity renders people unfit to approach God. To them, this is a moral issue; they’re judging Jesus’ disciples for improper behavior. Such thinking is common even today. People shocked by activities of which they disapprove –- drug use, unconventional sex, criminal behavior, even fashion choices –- sometimes decide that those whose outsides they are judging must be inwardly contaminated too, unfit for God’s love and undeserving of human help or compassion.

Jesus counters this thinking with the claim that dirty hands aren’t important. The heart, he says, is what matters, because the heart is the source of true evil, of the sins that arise from lack of love for God, self, and neighbor. Greed, dishonesty, hatred and selfishness are what make us truly unclean, and no amount of hand-scrubbing will rid us of them.

Here is a modern-day example. Several years ago, a homeless man was brought into the ER during my shift. The staff knew him well. He was a frequent flyer who’d been there countless times before and had run up a huge, unpayable bill. His skin and clothing were filthy, and he smelled horrible. But as bad as he looked, I was far more disturbed by his nurse. This was someone, usually a consummate professional, who had treated this patient many times before, but –- having worked without a break for hours that day -– simply snapped. I watched, disbelieving, as the nurse began screaming at the ambulance stretcher, “Why don’t you just die? You’re a worthless human being. You deserve to die!”

Which of these two people is more unclean?

That scene remains the single most upsetting thing I’ve witnessed at the hospital. But there are other, subtler symptoms of burnout and cynicism. I’ve never seen a sign that says, “Don’t scream at the sick people.” Such warnings shouldn’t be, and usually aren’t, necessary. Most of the staff are warm and professional. They didn’t go into healthcare to be mean. All of them start out wanting to help people, but some get ground down, tired, embittered by the gap between what they expect their patients to be like and who actually walks through the door.

Christians are God’s emergency-room staff. Like the medical professionals in the ER, we’ve made promises to serve everyone, regardless of background. Like medical staff, though, we often get burned out when the people we help aren’t well-groomed, polite, or sufficiently grateful. We get fed up when they keep coming back. We keep records of what they owe us, debts we know they can’t pay. We start listing reasons why other people deserve our time more, despite those pesky promises we've made.

ER personnel are required by law to serve everyone who shows up. Episcopalians are required by their baptismal vows to “seek and serve Christ in all persons.” Both groups know that the universal precaution against flu and the common cold is to wash our hands. Is there a universal precaution against unclean hearts, against unloving thoughts and behavior?

This morning’s Epistle says, in part, “Religion that is pure and undefiled before God . . . is this: to care for orphans and widows in their distress, and to keep oneself unstained by the world.” In this context, I think being unstained by the world means freeing ourselves from the love of power and prestige. Orphans and widows, and others who’ve been abandoned, aren’t powerful or famous. But helping them, even when they’re smelly and ungrateful, is the key to a clean heart. Helping the powerless of the world means rolling up our sleeves and being willing to get our hands dirty, even if –- properly cautious of germs –- we scrub them with soap later.

I don’t know what the universal precaution against lack of love might be. I’d like to hear all of your ideas on the subject. But here’s a start. The next time we see someone we don’t want to help, someone we consider unclean, let’s look at this person until we can see Christ. To do that, we may need to remember that the woman in front of us is someone’s daughter, or ask ourselves what we’d want if the man on the ambulance stretcher were our son. Once we see Christ, let’s focus on that vision for as long as it takes to sing the Happy Birthday song or our favorite hymn, or maybe to say the Lord’s Prayer.

And then let’s reach out both of our hands in help, love, and kinship.



  1. Oh, that was beautiful. As for the universal precaution, the thing I have to stop and say to myself is, She's made in the image of God. And then I try and really get into what that means ('cause I forget), and when I really believe it, why then, I see Christ.

  2. Selena11:26 PM

    Just a couple of comments from a hospital chaplain.

    First, you say that hosptial staff "start out wanting to help people, but some get ground down, tired, embittered by the gap between what they expect their patients to be like and who actually walks through the door." These days, they are also worn down by the fact that they're not being allowed to do the work they signed up for: Because of staffing cuts, they have to do more work every shift, and therefore have less time and energy to serve each patient.

    Second, I realize your audience for this piece is Christians, but the truth is that people of many religions, spiritual paths, as well as those who do not identify with either, have chosen to live their lives in service to others. Your sole focus on your own religion seems like an implied insult to the rest of us.

    A more accurate way to state your point would have been to speak of all people who serve simply out of a sense of compassion -- no matter where they learned it or to whom they pledged to do so -- and then narrow it down to your religion.

    In peace,
    one of your non-Christian sisters

  3. Dear Selena,

    Thank you for your comments. You're of course correct about the burnout issue. There are many additional factors as well, ones we could both name.

    As for the Christian issue, I've written about that in a separate post. I'll just say here, briefly, that no offense was intended.


  4. Selena9:12 PM

    Thank you, Susan, for your response here and for your follow-up post regarding my concerns about inclusivity. I appreciate your sensitivity. There's a subtlety here that I can't seem to get into words, so I'll just drop it.


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