Would an Ebola Quarantine Work?

quarantineThere has been a lot of buzz about the possibility of quarantines of health care staff. It is time that someone explained how a quarantine works and discussed whether it makes sense in this setting.

What is a Quarantine?

An important distinction needs to be made between quarantine and isolation. Isolation is to take people who are infectious and isolate them to prevent them from spreading the disease. Isolation can be mandatory or voluntary. Historically, Ebola has had mandatory isolation but for the most part, patients and families were willingly isolated to prevent the spread of the disease to others. Isolation is very good practice for a disease like Ebola.

A quarantine is more aggressive. Quarantines are where a population of healthy people are isolated because they might become infectious. They are usually involuntary because no one wants to be locked in with infectious people. It is usually accompanied by aggressive state actions to enfoce the quarantine.

When would a Quarantine make sense?

The justification for a quarantine requires two elements. First, the illness must be infectious. It would make no sense to quarantine cancer patients because they can’t transmit their disease. In the epidemiology community, the measure of infectivity is the Basic Reproduction Number or R-Naught (written as R0). It is the number of people you would expect, on average, to get an illness from an infectious person. Influenza has an R0 of 2-3, smallpox 5-7, measles is 12-18. The 2014 Ebola outbreak has an R0 of about 1.7 in West Africa. In the US, it is much lower with only two transmissions from the seven patients who have been treated.

The second factor is the severity of the illness.  Ebola, of course, is one of the deadlier illnesses out there, so its severity is certainly enough that isolation and quarantine are worth considering.

Both factors are important. Rabies and Mad Cow disease, which are nearly %100 fatal, do not require a quarantine because they are relatively difficult to transmit. Chicken Pox may be very infectious, but it is not so severe that we should consider isolation and quarantine. We would live in quite an oppressive society is the common cold was justification for isolation just because it was infectious despite the fact it is fairly benign as an illness.

What are the Advantages of a Quarantine?

At least in theory, quarantining an illness should isolate it to a small group of people where it can be safely treated or allowed to fizzle out on its own. To separate the potentially sick from the healthy does protect the healthy and may minimize the spread of the illness.

Another major advantage of quarantines is that they are a simple solution that makes the healthy feel safer. Quarantines are usually done by the healthy to the potentially sick. It allows the local leaders to say they did something which pacifies a frightened public.

One of the most justifiable and terrible quarantines in history is Typhoid Mary, who was an symptom free carrier of Typhoid. She was quarantined for 26 years of her life to protect the public from the outbreaks of typhoid that followed her. She was essentially imprisoned for life because of a disease she had.

What are the Disadvantages of a Quarantine?

Quarantines are not particularly effective. The only moderately effective quarantine I can find is management of Mad Cow Disease. It involved slaughtering 4.5 million head of cattle, which was the only effective solution because Mad Cow is universally fatal and untreatable.

Of course, this is not an option for humans. Quarantines have been rare in modern times. In 2007, a man named James Speaker was quarantined with extensively drug resistant tuberculosis. The last American quarantine before him was in 1963.

Quarantines can pacify a large segment of the population, but they often enrage the quarantined. During a smallpox outbreak in 1983, Local authorities attempted to quarantine the municipality of Muncie, Indiana. The population did not believe they had smallpox and several local officials were shot. Not only was the quarantine unenforceable, it created more problems than it solved.

Another difficulty of quarantines has been how often they are thinly veiled racial oppression. When a majority views a minority as dirty or disease ridden, it lowers the threshold necessary to quarantine them as a group. In 1900, California quarantined a section of San Francisco which was almost exclusively made of Chinese immigrants and their businesses. The effects were devastating to the local businesses and the quarantine was later thrown out by a federal court.

Does a Quarantine make sense for Ebola in America?

Ebola is certainly a dangerous illness with a 70% fatality rate in West Africa. A quarantine was tried in Liberia and Sierra Leone and both seem to have had no benefit and generally only aggravated an already tense public.

Ebola also is quite contagious to those performing funerals and direct caregivers of the sick. So the basic criteria for a quarantine are met in West Africa. Despite this, the quarantines that have been tried were failures. The energy and resources placed in the quarantine would have been much better spent on caring for the sick.

So would and Ebola quarantine in America make sense? The severity of Ebola in a modern health care setting has been much better than in Africa. There has been one death of Ebola in the US with this outbreak of the seven who have been treated. The death of Thomas Duncan was not surprising because even when he came for treatment in Dallas, he was sent home for several days. Despite this, Duncan only gave Ebola to the people you would expect him to transmit to, direct caregivers.

In fact, despite a botched handling of that outbreak, no one in the community developed Ebola. This is consistent with European treatment of Ebola patients where only direct caregivers of the sick have gotten Ebola.

So Ebola is not as severe nor as transmittable in a Western setting. This is not surprising as the toilet may be a greater safeguard than anything else. To take those infected body fluids away and have then adequately treated is probably more important than all of the personal protective equipment on the planet.

Taking all of this into consideration, I think a quarantine of health care workers or civilians who are not sick (which is to say, not contagious) would be neither effective nor beneficial. It is a political band-aid for a non-existent problem. In the history of this outbreak, no one has caught Ebola from a Western health care worker and no one has caught Ebola on a plane. There is simply no evidence to justify a quarantine.

But if even one person would get Ebola, wouldn’t a quarantine be justified?

This is an objection I have found is pretty common. As long as the life of a West African carries as much weight as an American, then this makes no sense. The small risk of an American getting Ebola much be weighted against the hundreds and thousands of lives that traveling health care staff going to West Africa can save. It only makes sense to say this if their lives don’t count. And their lives count!

Isn’t it selfish of those health care workers to risk the public by not quarantining themselves?

No more risk than when you get behind the wheel of your car. 34,000 Americans die in car accidents every year, so far one has died of Ebola ever. When you stop driving for public health reasons, get back to me.

As I have argued before, the burden on the health care workers who go overseas is heavy and to make it heavier only discourages us from going, which is a loss for everyone.

In conclusion

Let me end by asking that we, who want to go to West Africa, not be hindered. Care enough for the dying in West Africa to allow us to go and do what we are good at. It is no risk to you and a very great risk for them. Love them enough to overcome your fear.

And even if you are afraid, know that quarantines don’t really work that well. Find a better solution before you shackle us with a quarantine.

-Chip

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Seven Difficulties Health Care Workers Face to Fight Ebola

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As a nurse, I am one of the many who wishes to run toward Ebola. Don’t credit us with too much courage. We of all people know how manageable Ebola is and how few health care workers get it when good precautions are used and how many fewer die when given good treatment. Ebola is not as dangerous as advertised.

We see how many will die in West Africa if no one runs toward the explosion. In our protective gear, we are quite safe from contracting Ebola unlike the people of West Africa are in danger with about 70% of the infected dying. With the total cases now crossing 10,000 and a bleak future ahead if nothing changes, we feel the urgency to go.

With the new quarantines in New York, New Jersey, Illinois, and Florida, it is becoming increasingly difficult. There is a presumption on health care workers that our time and resources are acceptable sacrifices so that Americans can feel safe from their irrational fears. While West Africa is in serious danger, America is not. Even if 1000 sick patients got in a plane today and flew to every major American city, the outbreak would be under control within a few weeks.

The very first case of a nurse returning to the U. S. from an Ebola ward shows how needlessly aggressive the quarantining of health care workers can be. She was not treated as a kind person who took a risk for others and more like a  criminal waiting for the DA to charge her.

I don’t believe the public at large understands the sorts of barriers we face in getting to West Africa.

I hope to show you the difficulties I have faced in my own attempt to go to Liberia so that you can see that our help should not be presumed upon. We are not asking for your support as much as we ask that you not stand in our way.

1. The Fear for my Family

My greatest fear in all this is to come home and give Ebola to one of my kids. This is a remote possibility and a devastating one. It weighs so much on me that I plan on not returning home for the 21 days I could be infectious.

Lest I be accused of being hypocritical, I am not returning home because I can’t avoid close physical contact with my kids or my wife. It’s hard to avoid close contact with the lady sleeping in my bed or the kids climbing in my lap. I plan on returning to work (I have a phone job, so no close physical contact there either) and resuming my normal life. The public is at a minimal/non-existent risk and my life is not terribly inconvenienced.

Additionally, I will be checking my temperature multiple times a day and would promptly report a fever to the authorities. It is entirely possible I will be hospitalized with full protective gear for a minor stomach bug, but so be it.

2. The Fears of my Family

The next greatest weight we carry is the fear of those who love us. They mean well and wish for us to be safe. Of course, if I were sick with Ebola, my family would hope someone who had the resources and knowledge to help would come from far away to help me. I am hoping to be that person for someone else’s son or sister or mother or friend.

Their concern is not crazy. This is a dangerous disease. I don’t fear for myself because I am not in particular danger, but I understand their concern.

3. The Financial Pressure

When I go, I will be using my vacation time to do it. In fact, to even take three weeks of vacation time is difficult for my employer. I can’t support a house payment and our other expenses while taking significant time off. In addition, I am adding some expenses even though most NGOs pay for the travel and expenses there. Who will shovel my driveway when it snows? There are countless little things that need to be attended to while I am gone.

4. Work Pressures

My employer has been very understanding of my trip. Even so, many of my coworkers aren’t thrilled with the idea that someone who has been near Ebola will be working in the cube next to them. I suspect that I will given a wide berth when I arrive back.

Additionally, I feel that because people would be concerned that I should alert them that I have been to an Ebola hit country. I don’t want them to wonder if they should have shaken hands with me. They should be afforded the courtesy of making that decision for themselves even if I am comfortable with it.

 5. Public Pressures

Many health care workers have been afforded a return from West Africa like the Vietnam Veterans received. Many are thankful for their sacrifice and a vocal and frightened few are quite vicious to the nurse who was needlessly quarantined in New Jersey.  Here are several choice examples just posted in the comments from the link above:

Nurse Medusa with the outdated snake hair,showing her true liberal democrat selfish roots.

Then Jesus said, ‘How selfish of you to care for the afflicted at risk of your own life. And how dare you complain about unwarranted ill treatment on your return. You must be a liberal. I hate you’.

If she was a responsible health provider, who respects her profession and her fellow Americans, she would have quarantined herself for 1 month before stepping on a plane home. Isolation is a key factor when trying to contain an epidemic, one does not have to work in the health sciences field to figure that out. Selfish and ignorant!

I now see the Kaci is going by private carrier to her home in Maine where she will “self quarantine”. A small part of me hopes she develops Ebola, and like the Dallas nurse recovers fully.

Additionally, we are treated like public property. There is no great discussion of the rights of these workers. As a libertarian myself, I have been stunned at the lack of discussion of the civil liberties of the health care community. We are not a resource or commodity, we are human beings.

6. The Difficulty of Even Getting To West Africa

It is not small feat to get the time to do the CDC training and get over to West Africa. While many of the NGOs pay for the travel, it is a lot of time and phone calls to even get to that point. We, like all of you, have busy lives with many responsibilities. Getting to West Africa is no small feat.

7. The Uncertainty of How the Government will Treat Us

When I take off in that plane to go to West Africa, at any moment the policy of Minnesota or the Federal Government could change requiring me to be quarantined for three additional weeks on my return. It would be a serious financial burden on my family if this happened.

A week ago, I might have agreed to go through JFK or Newark airport once I returned, now I will specifically request to avoid these airports to avoid the quarantines that have been placed there. There is even talk of health care community of flying into Toronto and driving home to avoid these onerous requirements.

Should I go?

As you can see, there are many barriers to going to serve these patients. I don’t want applause for this, I simply don’t want to be hindered. A few more roadblocks and, in the name of public safety, I will be prevented from going at all.

If we don’t go to help those in West Africa, this outbreak will spread and grow. Do you think that if Ebola exploded in Guatemala it would be contained well there. Wouldn’t it then march into Mexico and start walking across our own border there? The only way the U. S. will be safe from Ebola is if it is stopped where it is.

Without the aid of U. S. health care volunteers, it will never be stopped in West Africa. For their safety and for your safety, please let us go unhindered and return without barriers placed before us. If we don’t go, who will?

-Chip

Five Reasons We Are Afraid of Ebola

quarantineWhen Thomas Duncan, a Liberian man who lived in Texas, was diagnosed with the Ebola virus, the reaction in the community and the press was strong, surprisingly strong. I had anticipated fear when a case came to the US (something that was nearly inevitable), but not this level of fear.

Even as I write this, the headline story on the Drudgereport is Ebola is ‘disaster of our generation’ says aid agency. There are countless stories discussing every step Mr. Duncan took and the thousands of people he might have come in contact with. Unfortunately, Mr. Duncan died of Ebola. The news would have ended there except that two of his nurses have since contracted the virus. With fresh fervor, the hysteria reasserts itself.

This fear is out of proportion to the danger. It is no surprise that a patient gets Ebola and some of his caregivers get it. certainly there were serious failures of the health care system in this case, but if the total price we pay for those mistakes is only two infections, then we should feel fortunate. After puzzling over this for some time, I think there are a few explanations for this deep fear we feel as Ebola walked onto our shores.

1. We Overestimate Dramatic Deaths and Underestimate Boring Ones

Humans are terrible at estimating danger. We fear snakes when mosquitos kill a million people every year. We are afraid of bears when white-tail deer kill about 130 people a year. We fear flying when about 1.24 million people are killed in car accidents every year worldwide. We fear Ebola, which has killed about 5,000 people so far and yet ignore influenza which kills about 250,000 to 500,000 every year.

Ebola is definitely the diva of the deadly viruses. Symptoms such as vomiting blood, uncontrollable fever and shaking, terrible diarrhea, and bleeding from the eyes and ears make it a virus out of a zombie movie. If drama makes for great news coverage, then Ebola makes great coverage.

2. We Fear that Ebola will Spread in the US like it does in West Africa

One good watching of the movie Outbreak would make me fear Ebola too. While Ebola is not the virus in the movie, it is clearly based on Ebola. Dustin Hoffman is telling us to close the US border, right?

The fact is that Ebola is not as contagious as advertised. The lengths we are going through to establish Ebola as an airborne threat indicate how difficult it has been to show Ebola spreading through the air. But it does not spread like influenza or a cold virus.

Close physical contact accounts for most if not all of Ebola spread. Think of who got Ebola from Thomas Duncan, it was two nurses who had, you guessed it, close contact with Mr. Duncan. To worry that it is spread by casual contact is to borrow trouble. Certainly it is possible, but it doesn’t seem to be happening. If you are a nurse caring for an Ebola patient, an abundance of caution is justified. If you are a member of the general public in the US, any fear you have of getting Ebola is unwarranted. You should be more concerned about white-tail deer.

3. We Fear the Unknown

Ebola is very other. It is foreign to us: far-away. Ebola epitomizes the dangerous jungle illness that has never been seen on our shores. This frightens us.

Now that Ebola is here, among us. We’re not sure what to do. There is this feeling that we shouldn’t have to face this. It ought to be someone else’s problem. The fear of this unknown drives us to feel silly things like that we should be immune or protected from it simply because we are here and it should stay over there.

While understandable, the only cure for fear of the unknown is to get to know it. Knowing Ebola doesn’t cause panic, but like anything dangerous, we learn to treat it with respect. Far from being unknowable, Ebola can be known. We just need to take the time to learn.

4. It is an Election Year

Ebola has a great marketing plan going. It chose to arrive in America in the months leading up to a Federal election. There are countless candidates looking for a stage to be heard from. There are very few stages more popular than one that pretends to protect the public from a dangerous disease.

Playing on our fears to get our attention, many have blamed the Obama administration not primarily because they care about public health, but because blaming the administration is what one does to the opposition party in October.

This is understandable, but very frustrating when it aggravates some of our most uninformed fears. What galls me the most is that it is working? Certainly the CDC and the hospitals involved should have done a better job, a much better job. But by reading the headlines you would have thought hundreds or thousands had Ebola in the US, not just three.

5. There is a Deep Distrust of the Health Care Establishment and Politicians

There is a deep and growing distrust of the health care establishment and of politicians. After years of wondering if cancer treatments really help, if vaccines are safe, should we really have antibiotics in our meat, and asking just when they figured out that this drug has a tragic side effect, the casual observer has a general distrust of the health care establishment.

It is worsened when Dr. Friedman, the head of the CDC, represents both politicians and medicine. It is further aggravated when he does the tried and true political process of providing the same talking points answers no matter what the question is. We feel manipulated because we are being manipulated.

But just because he is playing politics does not mean he is wrong. I wish he would give the straight answers to the questions. No, he should not be fired. Yes, the CDC was too slow. No, closing the US border to West Africans would not help. Yes, America is safe from a large outbreak of Ebola. Maybe the political environment makes such straight answers impossible, but I wish he would give them.

To Love People, We Need to Calm Down

Most of the fear we are experiencing over Ebola is not justified. We are reacting to our own anxieties and prejudices and not to the situation we are in. Ebola is not a serious threat to public health in the U.S. Heart disease is, but it lacks the drama that Ebola brings to the table.

The fear we experience is preventing us from considering carefully how we should proceed. There is a chorus of voices demanding that people from West Africa be prevented from entering the US. This might prevent some US cases of Ebola and it would certainly sentence tens of thousands to millions of West Africans to die. Ebola has been successfully contained throughout Africa for decades and even recently the outbreaks in Senegal and Nigeria have not had a new case in weeks.

The fear of Ebola is causing people to demand that health care workers who have cared for Ebola patients be quarantined for 21 days. This sounds like a grand plan unless you are the health care worker who has bills to pay and a life to live. By placing this artificial requirement, you make it very difficult for nurses to provide care for these patient. It does not protect the public and it is a bandaid political solution to a non-problem.

We need to accept that some people in the US will get Ebola. Some of them will even be cute ladies with dogs. Some might even be nice people we would like. Ebola will be spread to a few in America and it will stop there.

The same cannot be said for West Africa. If you are there you should be afraid. You should be cautious in public places. They face the prospect of living through Ebola and starving in the famine that is coming. They are dealing with homes where mom and dad have died and children are left to survive on their own. We should see through the blindness of our fear and have compassion on these people. They are in danger and we are not.

-Chip

The Image Above is courtesy of Jason Scragz and used with permission.

Naming Dying

deathWe are deathly afraid of dying.

Many years ago when we moved off of our farms and were no longer conscripted to go to war, we stopped seeing things die. With the advent of penicillin and surgeries and chemotherapy and x-rays we became good at not dying…for a little while. As our babies stopped dying as often and our older people lived longer and longer, we stopped thinking of dying.

That is not to say that we stopped dying. All of us die. We just decided not to think about dying.

This was easier for a little while. With sickness and dying segregated away in hospitals and nursing homes, we could ignore them. This worked well enough for a while, but with the advent of the internet and the 24 hour news cycle, dying has been brough back into our faces. When a young man walks into a school and shoots children, we see it. When hundreds of West Africans die of ebola, we see it.

Many of us try to ignore it with much success. You can ignore death for decades of your life. But one day, one very uncomfortable day, death will find you. You will look into the eyes of a doctor who will tell you that you are going to die. Even when you run from it, death will find you.

Even though this reality if frightening, it is not one God has left us alone with. The Bible has a great deal to say about death.

Death is Bad

This may seem obvious, but I have heard Christians argue that death is good. This concept is foreign to scripture.

And the Lord God commanded the man, “You are free to eat from any tree in the garden; but you must not eat from the tree of the knowledge of good and evil, for when you eat from it you will certainly die.” Gen 2:16-17

Death is a curse, a consequence of rebelling against God. When we weep over the death of a child or the loss of a parent, we are right to do so. We were created not to die, but we do. This is tragic.

Additionally, throughout scripture, death is considered a punishment for sin and foolishness. The greatest crimes in all societies are punished with death. We deeply connect guilt with death because God made us that way.

Humans Live Beyond Death

The author of Hebrews says it this way.

Just as people are destined to die once, and after that to face judgment, Hebrews 9:27

Even when we die, our souls live on to be judged by the God who said we would die.

God Died to Take our Judgment

It is not just that we die because of our sins, God chose to die because of our sins too. When he said, “You will certainly die” it applied to him as well.

For while we were still weak, at the right time Christ died for the ungodly. For one will scarcely die for a righteous person—though perhaps for a good person one would dare even to die—but God shows his love for us in that while we were still sinners, Christ died for us. Since, therefore, we have now been justified by his blood, much more shall we be saved by him from the wrath of God. Romans 5:6-9

Far from being a cruel God who judges with no mercy, our God has chosen to suffer for us and to suffer with us.

So What?

As Christians, we need to not put our heads in the sand, pretending that our death is not coming. Quite the opposite, we need to be acutely aware of our deaths.

But we do not want you to be uninformed, brothers, about those who are asleep, that you may not grieve as others do who have no hope. For since we believe that Jesus died and rose again, even so, through Jesus, God will bring with him those who have fallen asleep. 1 Thes 4:13-14

We are called be live as those who have hope. When we secretly deny death we are clinging to this life as if it were the only life we had. The myth we believe is that we can keep this life for even a little while. Sooner or later, maybe even tonight, we may die.

But think of the freedom of not fearing death. Imagine for a moment how free to go out into a dark world and do good. If there really is an eternal and wonderful future with Jesus before us, how free we are today to give ourselves to a dying and dark world.

Christian, think often of your death. Don’t run from it. It will probably be painful and frightening, but imagine suffering through it to walk out the other side and look into the eyes of Jesus. The pain you feel in death is the last pain you will ever feel. Let’s not live as those who have no hope. Let’s embrace the hope we have and harness it to take risks in the world we live in today.

Might as well, we’re going to die anyway.

-Chip

 

Why I Love Godzilla (and you should too)

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A statue of Godzilla in Hibiya, Japan. The first city he ever destroyed.

Ever since I was a wee lad sitting in my parent’s living room, I have loved Godzilla. The King of Monsters has been turning Tokyo to rubble to my great delight for over 25 years of my life. My love for him is not simply a love for destruction, any disaster movie can meet that need. Godzilla is special.

A little history may help. Godzilla was born on August 6, 1945 when the United States dropped the first nuclear bomb on Hiroshima, Japan. three days later another bomb was detonated of Nagasaki. Over 100,000 people died in those blasts and the psyche of the Japanese people was forever changed.

The trauma from the sudden and irresistible destruction lead to a feeling of powerlessness. The creative minds at a Japanese production company named Toho developed a metaphor for this destruction: a 150 foot tall amphibious reptile that no military might can stop.

The name of this monster, Gojira, is a combination of the Japanese words from gorilla and whale. The film was released in Japan with great success and was later released in the United States in a much edited form (whole characters and plot were added). The American version, called Godzilla, was also a success and led to 28 films created to date and the 29th to be released Friday (I refuse to count Godzilla 1998 even though Toho did license it as a Godzilla film).

Godzilla is strange in the sense that he is neither good nor evil. He is more like a hurricane which has destructive power, but not moral accountability. Godzilla is often territorial and throughout many films he has defended Japan from the onslaught of other monsters. I guess he feels like leveling Tokyo is his job and no one else’s.

Godzilla has always been created/awakened by the US nuclear tests in all of the films. He has always himself been radioactive and breathes a radioactive fire that destroys just about anything. Godzilla can breath underwater and spends most of his time in the ocean. Generally, Godzilla likes to do battle with other monsters in cities. Why fight in an open plain when there are buildings to be toppled and helpless Japanese business people to step on?

One strange quality of some of the best Godzilla films has been the very personal touch they carry. In Godzilla 1954 (the original film), there is a scene with mother holding her little girl as Godzilla approaches. She is whispering, “It’s OK, we’re going to your daddy soon.” She is then crushed by a falling building. It is a reminder of all the real people who were killed in the nuclear blasts over Japan.

He is more than just a mindless beast who creates rampant destruction. Godzilla represents the deep feeling in all of us that our actions have serious consequences. The argument is always that man’s hubris in using nuclear weapons has created so much destruction we never intended. You can feel however you like about nuclear weapons, but the overarching theme remains. We are more powerful and more foolish creatures than we ever realized. Godzilla is our judgement. Godzilla is our rescue from ourselves.

And that is why I love Godzilla.

-Chip

The picture above is from the Wikipedia Commons and used with permission

As I Lay Dying

car accidentI never saw the ice.

Awakened by a tapping on the window, I look around. My head is bloody and resting on the door of the car, which is resting on the ground. The steering column is pressed against my chest. Each breath is very painful as I feel several broken ribs grinding on each other. My legs are pinned to the floorboard while a pool of blood begins to fill the broken glass to my left as the driver’s side window rested on the snowy ground.

Tap Tap Tap…

I look up across the width of the car too see a face looking down to me.

“I’ve called 911, there help coming for you man. Hang in there.”

I recognized the face of the trucker who had done his best to avoid hitting me. His face now showed grave concern. He had no way to get to me and I imagine I looked terrible.

Another agonizing breath.

I know I’m in trouble. I have a lot of blood coming out of my arm, my head is swimming. It will take them some time to get me out, probably too much time. My thoughts drift to Sam and the kids, what they will do without me. How will they be financially, emotionally, spiritually? Who will walk Rosie down the aisle at her wedding? Who will shovel the driveway? Who will support my boys through the disappointments of life?

I begin to panic. I need to survive. They need me. They need me to survive this. Yet a quick look at the blood I am losing reaffirms my belief that I am certainly dying.

“Sir,” I said weakly.

“Yeah man, I’m here.”

“I need you to tell my wife something.”

“Now don’t go talking like that. You’re gonna make it. You’re gonna tell her it yourself.”

“Shut up! I need you to remember this.” I yelled weakly. “I need you to tell her that I love her and that I am so sorry I can’t walk through life with her.” I inhaled with a harsh gurgling sound. “I need you to tell my boys that I love them and that I am proud of them.” Another painful breath. “I need you to tell Rosie that I have loved being her Daddy and that she is so beautiful.” Another breath, this one came a little easier. “Promise me you’ll tell them.”

“Dude, I don’t need to tell them. You’re gonna tell them. You’re gonna come out of this.”

“Promise me you’ll tell them.”

“OK, I promise. Now you tell me that you’re gonna make it.”

I was going to make no such promise. The reason for my pessimism was the same reason for the urgency in his voice. In our hearts, we both knew I was, in fact, not going to make it.

I saw some blue and red flashes on the man’s face and he quickly left to direct them to me. I passed into unconsciousness…

It is a strange sensation to die. The pain begins to fade as my grip on this world loosens. It is more pleasant that I would have anticipated before. The grinding of my ribs fades to obscurity. As my physical eyes close, I begin to have another sense. An awareness of things that must have always been there, but indiscernable.

It is like sight, but not like it. There is awareness of direction of things, of a beauty to the worlds that I missed before. It is like seeing the significance of something directly. Before I would use a poem or a painting to show me what I could not see, now I see it.

This is most acute with persons. I can feel the paramedics coming toward the car and I can see them. Not their bodies, their spirits. I see the man whose exhausted from a long shift and wishes he was home. There is another younger man who is excited to be on a real accident site for the first time. I can see the apprehension and guilt of the truck driver who is questioning whether this was his fault.

What is striking though, is the crowd of people there I hadn’t seen before. Thousands of them, tens of thousands. They stood in a wide half-circle looking at me. Sweet expressions of anticipation. They had been waiting for me. Waiting with excitement.

I recognized a young and beautiful woman toward the front. “Grandma Brushaber,” I said.

She smiled and nodded. I had never seen a soul smile along with a face before.

Looking over the crowd, I saw them. So many faces I recognized. Souls I recognized. Nanny, Jean Viar, Miss Quincy, Grandpa Gruver, and a vibrant and healthy Joshua Gruver.

It was strange to see Joshua’s childlike delight in the whole affair. While much of the crowd was somber and serious, he was honestly thinking of jokes about how I had found such a dramatic way to die. It was strange because the jokes were actually hilarious.

The other striking feature was the brilliance of the lights. So many lights. They were so crisp and bright.

“Grandma Hanson, I know what you meant when you talked about the lights!” I said. She smiled sweetly back at me.

But I knew there was someone missing.

“Jesus?” I said.

“We’ve come to bring you to him,” said a genial Danish relative who had prayed for me before I was even born.

It was then that I realized my body was still speaking even as I struggled to leave it. A paramedic had climbed down into the car with me and was doing his best to stop the bleeding. I couldn’t hear his words, but his urgent heart screamed, “Don’t you die on me. It’s not time to go to Jesus yet.”

But he was wrong. It was time.

Joshua and Grandma Brushaber helped me out of my body. I was a bit unsteady, but they are magnificently strong, not wavering a bit even though I am taller than both of them. We walked together as the crowd parted to allow me to pass.

Then he arrived. A small man, not taller than five and a half feet, came running through the crowd. He was obviously middle eastern, but even more obviously the God of all things.

He jumped to me and hugged me with an intensity I could never have imagined. Even though I could not see his eyes in our embrace, I could feel his heart. He loved me like I love my little baby children. It is a sweet and intoxicating love. It shouted off my soul and echoed back to his.

We may have embraced for a second or a thousand years, I couldn’t tell. But I had something I had to ask.

“Jesus, what about Sam and the kids. They need me.”

He answered with some words that I don’t remember, because what mattered was how concerned he was for them as well. He was worried for them too. It was not the desperate worry of the powerless but the delighted concern of one who can act. He was concerned for them and would make sure they were cared for. That was good enough for me.

“Let’s go meet our Father,” he said, “He has been looking forward to having you home.”

We walked through a bright doorway into a place that words don’t describe. It’s not because words haven’t been made to describe it, it is because words cannot be made to describe it. The place was like an explosion of joy filled an enormous room and kept bouncing from soul to soul and back to the God who started it all.

We walked together with Jesus occasionally stopping to tell me how happy he was that I was with him. I was struggling to understand why he kept saying that. Why would he be so happy to see me? I am the one who got to be happy to be with him.

As unimaginable as the place is, it is a pale gray shadow compared to the Spirit in the center.

He is magnificent of all magnificence. Even with my new eyes, I needed to shade them from his intensity. As Jesus approached him, I could feel the vibrating energy between them. It was just on the edge of being seen. It moved in an eternal and endless dance between them.

Of course that energy was not a thing, but a part of God himself. No one will ever see that mysterious Spirit, but his quiet presence is everywhere.

“Daddy, I want to bring you one of your boys. This is Chip.”

It was like watching a seemingly endless sea of joy breaking into a storm. The delight that Daddy felt at me being there was so…wrong. Why would he be so happy to have me? I am the one who is lucky to have him. I am the prodigal and he is the Father and Older brother who are delighted to have me back.

Questions like that do not last long in this place. There is simply too much to experience to think overly long about myself. Even as I bathed in those opening moments of Heaven, I knew I had an eternity left to explore this place and this God.

And that is how long it will take.

-Chip

Facebook’s New Gender Options Don’t Go Far Enough

gender restroomFacebook has recently broken new ground in the discussion of gender. The bold step has been taken to greatly expand the number of gender selections available to its users. You and I are no longer limited to the very stilted “male” and “female” that has plagued us for so many millennia. Soon such options as androgynous, bi-gender, intersex, gender fluid or transsexual will be available to all who wish to take advantage of it.

This is quite forward thinking for Facebook and is not just good cultural relevance, it’s good business. As our culture becomes more sensitive to gender it will be an asset to the dubiously gendered to not be chained to such labels in social media. With all of this progress, I think you will be surprised how I feel about it.

They didn’t go far enough.

You see, breaking the shackles of gender identity took courage, but it was really a feint to avoid the much deeper and harder discussion boiling under the surface. Sure this allows them to pacify those who don’t like the old labels, but what they are really doing is avoiding those of us who don’t just want to free of our gender labels.

That’s right, they are avoiding the discussion of species labels.

In a clever marketing gimmick, Facebook isn’t addressing those of us who don’t want to be stuck with the label of “human being”. It is a bit silly for the Amoeba-Americans among us to discuss gender at all.

Imagine my frustration as I log into Facebook one day and I see that I have all the gender options. I am a heterosexual male so no need to use one of the new options. But when I want to tell the world that I am a Tyrannosaurus Rex, no option for that. This is extra demeaning as I am going through the difficult process of trans-speciation from human to Tyrannosaur. I am in a no-creatures-land.

And I can’t even express myself in social media.

It is difficult to describe the hardship I felt as a child. I knew from a very early age that I was really a Tyrannosaur, but people only saw a human on the outside. The hurtful comments and strange looks. How many science classes have a sat through where I am told that I have been extinct for millions of years? The lunch lady always insisting that I eat vegetables on my plate even though I knew I was only supposed to eat meat. Seeing my brother’s skeletons ripped from the ground and displayed in museums. It’s a lonely life to be a Tyrannosaur.

Even the American Psychological Association has not recognized that being the wrong species is normal. Many of us who know we are wolves, cacti, plankton, and crustaceans are treated as “mentally ill”. The intolerance is staggering. It is all the more frustrating compared to the new openness to self-identified gender.

The trans-species community has been oppressed for generations. Far from the new open-mindedness toward gender, even the most liberal seem to shy away from those who know themselves not to be human. Imagine being trapped un a human body and yet feeling the inner horseshoe crab crying out from inside you.

In an age of ‘sensitivity’ and ‘tolerance’ there is no room for us. There are no special laws saying that keyboards should be made for those with two fingers, no requirements that vehicles be made to handle a large tail, no paperwork written in Tyranosaur. It is easier to ignore us than to take the time to understand our special needs.

So should we applaud Facebook? I think not. They are avoiding the real problem by acting as if gender is the only choice. We, who are in the trans-species community, know that this is not courageous. It is wholly inadequate. Gender isn’t the only choice we need.

-Chip

The image above is courtesy of David Wallace and is used with permission.