Acute and Chronic

No, I tell you; but unless you repent, you will all likewise perish. – Luke 13:3

In my former congregation there was a nurse manager who also was a teacher/trainer at the local college. One of her observations was the difference in how people and institutions reacted to acute and chronic problems. Acute is happening right now.  Getting shot is an acute condition. Chronic is ongoing.  High blood pressure is chronic. Her observation and complaint was that all the money went to acute.  All the trainees wanted to be in the ER.  Those positions always had higher salary and status. But it was the chronic conditions that needed the most help. Uncontrolled chronic conditions rolled down the hill further and faster, and you tend not to climb back up slippery slopes. Yes, acute could kill you now, but chronic could steal all the life from your life.  Yet the entire system is set up to treat the acute and rely on the individual to manage the chronic.  The individual who has already proven not up to that task. I find the model of care at the place where my wife works to be a fascinating experiment. The practice gets paid on trying to keep people with chronic conditions healthier. On managing them well. I believe it is one of the experiments enabled by the Medicare tweaks in the Affordable Care Act, but google fails me in confirming my memory.  The old MBA in me was always fascinated by business model experiments.

But back to the main thought, I was thinking about acute and chronic because of the Hurricanes.  Hurricanes are at first very acute.  They are happening now.  But as we see in North Carolina, they become Chronic.  Some of those hollows of Appalachia will just never be restored.  Or maybe if you are a radical environmentalist you are saying “no, they are being restored, to nature.” By the time Milton sweeps across Florida, Helene will be a distant memory.  Just another chronic condition.

When Hurricanes or natural disasters come around or the most recent acute trouble gets its 15 minutes, I often turn to Luke 13:1-5.  Acute disasters terrify us.  We think they are God’s judgement.  You must have done something to deserve that.  Karma’s a b.  You saw that in online responses to Helene.  “Stupid Trump voters deserve it.” In Luke Jesus gets asked about “some Galileans whose blood Pilate had mingled with their sacrifices (Luke 13:1).”  Part of Jesus’ reply is to bring up a prior 15 mins, “what about those 18 on whom the tower in Siloam fell?” Acute disasters.  Why did they happen?  Maybe more pruriently, “what did they do to deserve that?” Jesus, who could read hearts, apparently thinks that is what they were thinking.  “Do you think that these Galileans were worse sinners than all the other Galileans?…do you think that they were worse offenders than all the others who lived in Jerusalem (Luke 13:2,4)?”

Jesus takes the acute and the natural human fascination with the acute and turns it to the chronic. Blasphemous sacrifices and falling towers demand immediate attention.  But Jesus says, “No, I tell you (they were not worse sinners for suffering in this way), but unless you repent, you will all likewise perish (Luke 13:3).” Sin, the cause of death and decay, is the ultimate chronic condition. And occasionally the fallen powers and principalities throw up a horror that makes us pay attention.  But per Jesus there is nothing special about such horror or tragedy. We should not assume “they deserve it” and the corollary that we get to play little Jack Horner sitting in a corner thinking what good boys we are. The acute should force our gaze to the chronic.  We are all sinners. And we cannot save ourselves from our sinful condition. Leaving the chronic to the individual just winds up with everyone dead.

But there is a balm in Gilead. Our Chronic condition has been treated by the great physician. Repent and believe. The blood of Christ, sacrificed under Pilate, is the cure for the sin sick soul. His resurrection shall be ours bringing to an end the reign of bodily death. And those powers and principalities that occasionally rear up?  Their time is short.  

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