Several years ago a physician friend of mine went to a family party where a hypochondriac uncle approached waving his arm and asking "My hand has been numb lately, what should I do?" Now this uncle had been notorious for starting conversations with medical questions like this for years and was oblivious to the many broad hints that his requests for diagnosis and treatment was not appropriate at social gatherings. But up until this point, sage, generous and kind medical advice had been always been dispensed, though there was a more recent bent towards shorter answers, primarily of the "probably talk to your doctor about it" sort. On this occasion, however, the patience of this physician was used up. This time the uncle got a very short answer. When he plaintively asked "what should I do?" The answer was "probably amputate."

I decided to start today with this story because I've had a great deal of difficulty with this sermon and have become almost as annoyed at the question "what is suffering" as this doctor was at the ill timed medical questions . When I talked to Richard weeks ago and told him I wanted to preach a sermon on suffering, I had no idea what kind of fix I was getting myself into. On the one hand, I wanted to speak honestly about suffering. I wanted to be sufficiently graphic to do justice to the great pain that humans have experienced over the years. On the other hand, I wanted to avoid the maudlin sensationalism that is practiced by so many of the agencies that fund relief efforts either for medical illnesses or for the sufferers of various natural and man made disasters. I am not after your money this morning, just your attention and your thoughtfulness.

What is suffering? Is this uncle suffering? Of course he is. His endless search for reassurance and his preoccupation with his frailty is a form of suffering. Yet it does not inspire great sympathy, in fact, instead, it inspires annoyance. He is suffering, but not enough to excuse the thoughtless self involvement that prevents him from seeing the needs of others around him.

At the other extreme are the stories we hear in the media. The floods in Madagascar. The oppression of Mexican Indians in Chiapas. The grinding poverty that results in starvation and malnutrition in many spots throughout the world.

Each time I use my Netscape program it opens to a page called "The Hungersite." Under a map of the world it says "Every 3.6 seconds someone dies of hunger. Three quarters of the deaths are children under 5." Under this statement is a button that says "donate free food." When you click that button, which you are allowed to do once a day, you go to a page with sponsors who each donate a quarter cup of staple food - rice, wheat, millet - every time someone downloads this page. Sponsors range from Sprint, Proflowers.com, to other unnamed sponsors who have banners that proclaim things like "free auto insurance quotes." The hope is, of course that you will click on their banner and proceed to their website where they will trade on your good will and sell you their product or service. I've done business with some of these companies. I think its a great way to advertise. More importantly, clicking daily on this button keeps this state of affairs on my mind. I don't click this button without sadness and a wordless prayer.

Hunger of this sort must be suffering, as is enduring floods and earthquakes and other natural disasters. But what about the loss of homes to hurricanes when they are built irresponsibly on the sandy beaches of South Florida or South Jersey? When does it stop being suffering start to become a deserved consequence of foolish behavior?

Regardless of my difficulty understanding, there is no question that there is a great deal of suffering in the world. The suffering comes from pain or loss, or from the fear that the anticipation of pain or loss can generate. This suffering underlines the human fragility that we all share. It merits our tears..

Late last year I returned to one of my nursing homes after a weeks vacation to find that a friend of mine and a well loved retired minister who had been coping with the symptoms of a number of small strokes had taken a turn for the worse and was staying in the skilled nursing section. The staff, many of whom knew him when he was well, was traumatized by having to care for this respected man who deteriorated rapidly over the months and is now gone. In his confusion he committed acts that would have embarrassed him had he been aware and which mortified the staff who had to care for him. As he declined he entered a period in which he cried out constantly from pain that in his confused state he could not describe. His physicians and nurses tried to diagnose and treat the cause of the pain, but finally gave up and treated it without a complete diagnosis. His last days were quiet ones, unconsciously breathing oxygen enriched air. Yet even in the horrible suffering of this experience, there were moments of comfort. "At least he doesn't know what he's doing," one person commented. When his verbal skills began to leave him, his daughter told me, his ability to pray lingered longer then his other skills. In my last conversation with him he remembered that I was a colleague and told me that he wanted to talk to me sometime about utilizing the gifts of the fine young people in the church, a concern that I believe lingered from a life spent nurturing the lives of others. After his death his family had a prayer and sang a hymn through their tears. After witnessing the last weeks of his life, and in the midst of their grief, they were thankful that God had released him from his suffering.

I've see a full range of distress in my work. Some folks are distressed because of things that would make almost anyone cringe in pain -- parents who have lost their children, people who have lost jobs on which their identity rested or their independence due to declining health, people who live with constant pain. I've also been exposed to distress that is harder to see. Some people are miserably depressed because they have not met their own, unrealistic, expectations for themselves, or because they have ranked themselves by some unfair measure and have found themselves wanting. Some people believe that they are unloved or unlovable.

The suffering in these situations, even when it is hard to see from the outside, is invariably real. I did not doubt that those office patients who, by all measures should be happy as clams, came in to me because they really experienced distress. It may not look like it should hurt, but it does . Recognizing this is often the first step to recovery.

On the other end of this are those times when pain seems to be powerless. Did anyone hear about the Sixer's game with the Celtics the other night where they won in double overtime? How many of the Sixers were playing hurt? A couple, I think, I know Iverson was. Sports psychologists have examined the performance of sports hero's who play in pain and sometimes continue to not only play competently, but often have stellar games. Pain that might knock one of us off our feet for days doesn't seem to stop them from winning their games. Pain that by external examination might appear to be extreme only seems to drive them to greater levels of achievement. What is it that athletes experience that makes it possible for them to transcend their pain?

This same phenomenon has occurred in more sacred domains. Remember the story written in Acts, chapter 16? Paul and Silas caste a spirit out of a slave girl that allowed her to tell fortunes. Her owner, angry at his loss of income, incited the crowd and the local authorities and had Paul and Silas flogged. Reading vs 23 to 25:

23After they had been severely flogged, they were thrown into prison, and the jailer was commanded to guard them carefully. 24Upon receiving such orders, he put them in the inner cell and fastened their feet in the stocks.

25About midnight Paul and Silas were praying and singing hymns to God, and the other prisoners were listening to them.

They were in a cell, in stocks having been stripped and beaten and they were singing.

This also happened at other times in more recent history. Consider the story of Lijsken Dircks, wife of Jerome Segers who was imprisoned after declaring her disdain for infant baptism in 1551. After being judged and locked into prison, it says in the Martyrs Mirror (Herald Press, fifth edition, 1950): "She spoke boldly and valiantly to the people, and sang a beautiful hymn, so that the people were greatly astonished." And later it reports her death: "They took (her) to the (river) Scheldt, thrust her into a bag, and drowned her, before the people arrived, so that but few witnessed it. There were some, however, who saw that she went boldly unto death, and valiantly said: 'Father, into Thy hands I commend my spirit." (p. 522)

It seems that sports hero's are not alone in being able to transcend pain and fear and continue to function, even at high levels during times that we would expect the pain and the anticipation of pain to produce debilitation.

Who is suffering in these situations? Of course Iverson and company were not suffering on these occasions, though perhaps the Celtics were. Where is the line that distinguishes the normal aches and pains of life from the tragedy of human suffering?

When I started my practice I used to give a talk called "All the way to 103 the Challenges Never End." When I pitched this talk to the local librarian I told her it covered the normal trauma's of life. As any good wordsmith might do, she questioned me. Normal trauma, she pointed out, is an oxymoron. You know, like military intelligence, or honest politician. The two are contradictory. It made me think through my premise, but I didn't change the description. It is normal to suffer through traumatic transitions in life for most of us. I've not heard any of my friends say "Oh, I loved puberty." Nor have I heard any of my septe and octogenarian patients say "Yeah, raising children, that was a breeze." Or "Boy, I wish I could go through menopause again."

What is suffering? In the ten years that I've been seeing people over 65 I've never heard a single one of them say he or she was afraid of death. Not one. Researchers tell us that the fear of death is rarely a concern of those over 65. More typically this fear, when present, is in people between 50 and 65. What my older patients fear is the pain that precedes death, or, even more frightening for some is the fear of the indignity of a dementia like Alzheimer's disease. And more puzzling still is that I've seen more then one person who suffers pain on a daily basis whose primary presenting problem is not coping with that pain, but the fear of what is yet to come. Pain, they understand. The suffering comes from their fears.

There is, indeed, a great deal of suffering in the world, of all different forms. The suffering can come from pain, or from other losses. The anticipation of suffering can cause fear and more suffering. This suffering underlines the human fragility that we share. Many tears have been shed.

When I first conceived of preaching a sermon on suffering, I thought that I was truly qualified. I see suffering during every week of work. Susan brings home stories of suffering on a regular basis. Personally I've experienced what might be considered suffering -- the sometimes bone numbing fatigue I get from my MS, the pain and curtailed lifestyle I get from heart disease, and, perhaps most traumatically, the shocking loss of my parents in an automobile accident less then a year ago. It seems that I should be qualified to explain what suffering is to you and have some insight into what it means. Yet in thinking about this sermon and in trying, on many futile occasions, to write about it, I've found that I do not understand suffering.

I've grown inured to suffering in many ways. Having found that I can survive and still enjoy life despite difficult physical illnesses, I discount the suffering involved in such things. You see, I compare my suffering to that of my patients, or to that of people who are living in places where rice and beans may be seen as a feast and I don't see how I can consider what I am experiencing as suffering. It doesn't compute. Sure, I have one or two fatigue days each week when I really can't do much more then sit in my recliner and cruise the 'net or watch movies or TV. But, my goodness, I have access to the Internet from my own home and all kinds of access to movies and books to entertain me. And I have multiple comfy chairs, and also a couple of beds to rest in. And sure, I try to keep a bottle of nitrostat pills close at hand for under my tongue when I get angina, and I can't eat the high fat gourmet foods I used to love, but, my goodness, I can eat all kinds of beans and rice and I can buy fresh fruits and vegetables from the grocery and there is still a huge selection of wonderful things to eat and I have absolutely nothing to complain about.

I am often very anxious when I think I might be overdoing and anticipate that I may get more pain or more fatigue. Once in a while I worry what my life will be like in ten years, though usually I try not to think about it. So I know what pain is and I know what fear is. I certainly know about human fragility. I've shed tears. But I am still not sure that I know what it means to suffer.

Susan gave me an article several days ago, an article I was very happy to get, because having reached this point, I needed some help. It was written by Dr. Eric Cassel and appeared in the New England Journal of Medicine in 1982 and is called The Nature of Suffering and the Goals of Medicine. In this oft cited article Dr. Cassel points out how infrequently medicine addresses suffering. Instead it addresses pain and illness and pathology, but not suffering. He suggests that this is a failing. I'm sure we all agree.

Dr. Cassel makes three points about suffering. First it is experienced by persons, defined by the totality of the person, body, mind and social context, second is that it occurs when an "impending destruction of the person is perceived", finally, the "suffering can occur in relation to any aspect of the person, whether it is in the realm of social roles, group identification, the relation with self, body or family, or the relation with a trans-personal, transcendental source of meaning." (P. 640, vol 306, no. 14).

When you think about suffering this way, the difficulties I was having with the concept are reduced. At different levels the unexpected absence of success can be suffering, the absence of needed reassurance can be suffering, the loss of physical capacities can be suffering, the life threatening absence of food or shelter can be suffering -- just as all can be endured when there is a over riding sense of self and purpose.

I'm sure Jesus knew the normal trauma's of life as well as a few that were not normal. There have been all kinds of speculations regarding how human he was. It seems that the rough agreement in this congregation is that, even though we worship him as God, he was very human when he was on earth. I'm comfortable with that. I expect he had the fears and heart breaks of childhood and adolescence, that he worried about the health of his parents. I'm sure he experienced hunger during the 40 days he fasted. There were probably a few other days too, since he was an itinerant preacher and didn't come home to a heavily laden table every night. I think he probably was afraid when Judas pointed him out to the soldiers, and when Pilate sentenced him to die. I know carrying a heavy cross after already being abused was painful. I'm sure the nails hurt.

Is this suffering? An old piece of artwork is etched in my minds eye of Jesus hanging on the cross, a tear tricking down his face. In my mind this picture is attached to the words "My God, My God, why have you forsaken me? The moment of his greatest suffering was not the pain, or the betrayal, but the thought that God had deserted him.

Each of us has our own pain. It is real, it may even cause suffering. It is not diminished because others also have their own pain. We are all surrounded by suffering in many ways. We protect ourselves from it by averting our eyes, by discounting the pain. This pain is not diminished when it is normal or typical. It is still real. It can still cause suffering. Just like Jesus pain was real, not only on the cross, but when he was betrayed and when he wandered the desert, and during all the rest of the normal traumas during the fragile years of his life on earth. Jesus joined us in our pain, in our fear and in our fragility.

Cassel wrote "Two other aspects of the relation between pain and suffering should be mentioned. Suffering can occur when physicians do not validate the patient's pain. In the absence of disease, physicians may suggest that the pain is 'psychological' (in the sense of not being real) or that the patient is 'faking.' Similarly patients with chronic pain may believe after a time that they can no longer talk to others about their distress.. In both instances social isolation adds to the person's suffering."

It is the validation of human suffering that seems to me today to be among the most potent pieces of Jesus ministry on earth. On the surface we see in Jesus life just another freedom fighter or itinerant teacher born, raised and crucified in the Roman era. But as we examine the details and examine the response of our hearts to this man, we see that it was God who came to us to join us in our painful, frightening fragile human existence. God joined us and it eases our suffering. Now we too can join each other and our suffering will be lessened.

Cassel says: "I suspect that there is more suffering than is known. Just as people with chronic pain learn to keep it to themselves because others lose interest, so may those with chronic suffering." (P 644)

I agree. In fact, I will go further and say that I believe that we all know suffering, whether it is from the normal trauma's of life or from the extremes of deprivation, starvation and hopelessness. Suffering may be momentary or it may be long lasting, yet the fear of the disintegration of the person, the fear of the loss of the self, the fear of the loss of all we know -- these fears are familiar to us all. And it is of great comfort to me that God also knows the pain, the fear and the fragility of human suffering.

Before we enter into the ceremony of tears, and by way of underlining how important it is that we as a community validate the suffering of the individuals who make up this body, I would like to read a note that was posted on an Internet list to which I subscribe. It was written by a man who has endured quite a bit of physical pain because of bone spurs pressed into his spinal chord and the surgery that followed which relieved much, but not all of his pain. He writes:

"I was in church today for the first time in a long time because a good friend, who happens to teach the 4th grade, asked me to talk with her class about healing, since that was their lesson focus for today. I made the discussion very simple and refrained from pointing out that it's a confusing topic. How does one approach such a topic with 4th graders?

"I asked questions. There were 17 4th graders. When I asked how many of them could remember a time when people showed up from church to bring them food or mow their lawn or do other things because os some problem -- someone in their family was hurt or sick, or had lost or job, or there had been a death. Over half the hands went up. Then I asked how many of them had seen their mom or dad preparing food to take over to the home of a family that had experienced a death or had somebody who was hurt or sick. Every single hand went up. They were all more than happy to provide chapter and verse, but I quickly explained that I didn't want to talk about their parents, I wanted to talk about them."

My friend went on to describe how these children responded quite personally to loss or hardship that they had seen. He concluded:

"These kids know a lot about helping with the healing process. Some of them seemed surprised to hear an adult say that. Perhaps they won't forget my hope that they never lose the ability to love and hope as children, without seeing the faults of those who need healing. It was different than hearing adults talk about wishing other people well. These kids can wish for healing without being judgmental, and that's nice; quite wonderful, actually. Perhaps today's events in the 4th grade Sunday School class will become the basis for a sermon. Perhaps not."

These children can see that suffering cannot be measured by external means. They don't worry about judging whether someone's suffering really crosses the threshold that allows it to be called suffering, whether the suffering is real or 'psychological', whether it is a consequence of a bad choice or wholly undeserved. One persons comparative good fortune does not invalidate his pain just as an abundance of loss does not prevent one from experiencing joy and satisfaction. After the choir sings, please join in the ceremony of tears in this childlike spirit, where each of us has the opportunity to place our own suffering into the common basin of our life together, acknowledging our own pain just as we acknowledge the pain that we see around us.