HEALTH CARE
INDIVIDUALS AND NEEDS

1972 Religious Instruction in the Wards

A catechism course for the personnel at Mangiagalli Hospital Milan, requested by the director of the nursing school, Sister Agostina Fumagalli. Some notes from a lesson by Fr. Giussani

EDITED BY GIOVANNA TAGLIABUE


In 1971, Antonella Moglia and I enrolled in the ICP (Istituti Clinici di Perfezionamento) school in Milan. At that time the CL community was just starting to form at Mangiagalli Hospital. The director of the school, Sister Agostina Fumagalli, was fascinated by Fr. Giussani's words and asked us if he was available to teach a religion course to our class. We asked him, and he said yes. The religion hour, at first, involved about twenty first-year students. Then friends in the Mangiagalli community wanted to take part. Thus the hour of religion was moved to the evening in the large lecture hall of the Work Clinic. This way, everyone could attend: nurses from the hospital, medical students, and doctors. In all, about fifty people. Sister Angelica sat faithfully in the front row with her tape recorder. And today, thanks to her faithfulness, we offer you here her notes on some passages from a lesson from that course, given by Fr. Giussani in 1972.

1) It is not possible to give service to the world except by living or doing an action in accordance with its order, that is to say, except by doing the will of God, because the order of the world is God's plan. It is by doing the will of God that we serve the world, we serve men, we are useful to men. Otherwise, all the thrust of our good will and all the generosity of our good intentions cannot remove the final disappointment from our actions; that is, cannot take away the fact that our actions-with all our good intentions-serve our own way of conceiving of things, which is not the way of reality, it is not the true way. Just like a mother who, when her child is sick, thinking to do the child good, makes him swallow a purgative that causes him to die of peritonitis: she thought she was doing good, believed she was doing good. Things don't come from our hands, nor from the hands of the party leaders nor from the hands of the unions, nor the hands of geniuses or scientists: they come from something else, which is the will of God.
So then, this is the first factor. There is just one law: to love. Loving is conceiving one's life in accordance with something else, or better, in accordance with another (because you cannot love a thing, you love a person), thus conceiving one's life as the will of God: my will is Yours, my criterion for action is You, my criterion for action is Your criterion. This is love: affirming the other.

2) However, now there is a second factor to consider. Suppose that someone is full of complexes, or a bit confused, or has not had a religious, Christian education and is totally ignorant from the religious, Christian, moral standpoint (even if he is a senior doctor at Mangiagalli Hospital), or is in a moment of temptation, of some particular temptation. In these four cases, enacting the moral law, which is to do the will of God, is a little harder, of varying difficulty, than for me-let's say-in a moment of calm, in a period of serenity, with all the gifts of God that I have in my head, with all the training I have had, all the balance that (thanks be to God) my mother instilled in my nervous system, with all the help I have had along the way.
So then, we have to say, more generally, that each of us begins to act from a given situation. In action, man tends toward the ideal, and the ideal is to do the will of God, to love His plan, and thus to love the order of things, to conceive of himself and what he does in accordance with the entire order ordained by God. This is the ideal. But I, to reach this ideal, start out from different situations: one time I'm angry, another time I'm calm; one time I am a prey to temptation, another time I am more well-balanced and at peace; one time I am a bit rough around the edges, because I am still young, and another time I am more sober, because I am a mature man.
Man, to fulfill the ideal law, starts from a situation, a determined situation. The word instinct, instinctiveness, can be useful in clarifying this point. Man must enact the ideal, the ideal law, by embodying it, that is to say, by fulfilling it within a determined situation or by starting from a determined situation, following a certain conditioning.
I was saying that the word instinct could be useful, because I am made, man is made of an ideal conscience and a certain complex of instincts. But the word instinct is too limited: let's say "instinctiveness." Man, in every moment, carries a certain load of instinctiveness. For example, if I am angry, or have a headache, or am ingenuous or ignorant, or if I am ill-disposed or am complaining, all these cases represent a different instinctiveness as a starting point.
Therefore, let's call "instinctiveness" this factor, this component which in every moment of human life is given by what determines it; for example, by the past, by a person's nature, by what stimulates him or the reaction he has. So, we can also use the word "reaction." There is always a component of reaction. It is like, if we can use this word, the weight of matter. But it is not just "matter," because, for example, pride is not matter, self-love is not matter, but it too belongs to instinctiveness, to that whole complex of determination from which a person starts out. Hence, on a certain day, I am determined in such a way that it is easier for me to live love for the right thing and on another day instead, I am determined by my situation in a way that makes it harder for me to live the right.
More generally speaking, every human action is made up of an ideal factor (which is what we have said: the sense of right, of order, the will of God) and of a factor that instead is heavy (which is given by instinctiveness, determination, the situation from which every man starts out) which is the material aspect.
For example, a boy falls in love with a girl: this is the aspect that I have called instinctiveness, it is the situation from which he starts, the determination from which he starts, the aspect that is material or heavy, so to speak, the aspect of reaction. What can he do? He can give in to this reaction he feels, following it blindly. In that case the law, the directive of his action is that of affirming what he feels, it is fulfilling what he feels. Seen in only these terms, this is egotism, and it is immoral. We have said that the motive for action, that is, the law of action, the purpose of action is that of serving the world, or serving the will of God, to do the will of another (this is what love is). So then, what should he do? Should he become a monk? Certainly not.
The need to utilize or bend our situation in accordance with the ideal, which is being useful to God's plan in the world, is called duty. What is duty? It is bending, manipulating, utilizing our instinctiveness, our situation in accordance with the utility of God's plan; that is to say, in service to the world-which is the same thing. Duty is this functionalization, it is this relationship between what we carry within us, between our moment (with all the complex of instinctiveness, of inclinations, reactions, of good or ill will, etc., that we find ourselves bearing), and the overall design, which is to utilize this moment in accordance with the aim, which is to serve the Kingdom of God as much as possible; that is, to be as useful as possible to men ("Love your neighbor as yourself" and serve the Kingdom of God more fully).

3) The third element of the Christian moral conception is that man, according to Christianity, is not capable of doing this. Man is not capable of enacting this accordance, he is not able to make instinct a function of the true purpose, he is not capable of utilizing his situation for the utility of the great plan of God, and thus of man. He cannot do it.
Man senses that this is right, and he wants it, but he cannot do it, and if sometimes he really throws himself into it, maybe he succeeds for a little bit, and then he falls apart. Man is like someone who has been very sick and, when it is time for him to get out of bed, he cannot, he leans on his elbows and then falls, he falls down, because he is too frail, he rises up a few inches and then falls down. Theologians speak of man being aegrotus, sick.
But man is like this because something is out of place at his roots. More precisely, according to Christ's conception, all men-being profoundly linked to each other by a solidarity much greater than can be imagined by any communism or socialism, because it is a solidarity from within his very being-because of a profound solidarity, all the line of mankind has been upset by the introduction of evil at its origin, a responsible introduction of evil, because of a rebellion against God's plan from the very outset. This is the concept of original sin. This initial upset, this initial overturning, this initial disorder remains at the root of every person born into this world, so that man's base is equivocal, ambiguous; he wants to do good and he succeeds in doing ill.
Next, let's ask ourselves, what are the most decisive relationships that human experience can know? The relationship of love between a man and a woman, the affectionate relationship between parents and children, the relationship of service to others as in political work. But are there three phenomena which become the root of egotism more than these? No, none! No other phenomenon, no other relationship is more of a source of egotism than these, none!
According to the Christian moral conception, man alone cannot fulfill the law of love, he cannot help being an egotist. That is, he does not succeed in being truly human; man cannot fulfill himself ("Unhappy me, who will free me from this mortal division?"); man by himself cannot succeed in doing good. A council of the Church said as much in the seventeenth century: man cannot last very long without committing grievous errors; man, alone, cannot succeed; man, alone, is an egotist.
However, let's take up again the comparison of the sick man. This sick man, who has to get up, leans on his elbows and doesn't make it. But if his mother goes there, or his wife or a nurse, or the doctor, or a friend, and takes him by the arm, then he manages to walk, whether a little or a lot he can manage to walk. This is the image of the man who walks, according to Christian thought: man cannot walk unless he is embraced, unless he is sustained by Jesus Christ.
God came into the world exactly, precisely to take us and make us walk. Man cannot be himself except together with another, who is Christ, who is God who came into the world for this, "Without me you can do nothing." On the contrary, says St. Paul, "I can do all things through Him who strengthens me."
Once more, man cannot be himself except by depending on an Other; this is the natural law, it is the original law that is repeated at a more profound level. Man was made by an Other and cannot exist except by the energy God gives him, that the Creator gives him, and he cannot fulfill himself except with the help of a new and more profound intervention by God, by God who became a man, the man Jesus Christ. It is only together with the man Jesus Christ that man, that every man, that the human being can walk-I say-stumbling, falling a thousand times and a thousand times being born again, but he really walks only if he is united to this man who is Jesus Christ. God came into the world only for this, and He died for this. "Greater love has no man than he gives his life for his friends." Man cannot be himself, he cannot build himself, he cannot fulfill himself except within a friendship, except within a companionship, except within the companionship of Christ.



Nurses of All the World, Unite!

The international meeting organized by the association Medicina e Persona (Medicine and the Person)

BY ANNA LEONARDI


From the four corners of the earth they came, numbering more than 400. What attracted them to Bellaria, on the Romagnola coast of Italy, was, to be sure, not the echo of the Marxist slogan, but a seminar entitled, "Nursing: Occupation, Profession, Charity?!" The idea of a large-scale meeting came to a nurse, Giovanna Tagliabue, with 25 years of professional experience behind her, spent first in the Health Centers in Zaire and then in a medical school in Paraguay. After many years in her profession, she found herself wondering, "How do I work?" Further, she was feeling the need to go more deeply into the reasons why nursing is worth it, when it is so poorly appreciated by a society that nonetheless calls itself humanitarian. Last August, during a brief sojourn in Italy, she got to work, beginning by contacting old nursing friends, and together they organized the meeting. Five days later Giovanna left for Villa Rica, Paraguay.

Treating man
The three-day conference began on February 8th at the European Congress Center in Bellaria. The outline of the meeting, organized by the association Medicine e Persona (Medicine and the Person), was a response to a challenge launched fifteen years ago by Fr. Giussani at a three-day conference of nurses in Varese. There, immediately in his introductory address, he focused on the core of the problem: "The question is the unity of your person within your profession," so that the "I" can live fully, in its work, "all those human needs and urgencies which God gives us." And to live this fullness, Fr. Giussani had repeated numerous times, "You have to put your heart into what you do. And for this to be possible, it is necessary not to be alone."
"What are human beings that you spare a thought for them, or the child of Adam that you care for him?" Giovanna Tagliabue opened the proceedings of the meeting with this verse from the eighth Psalm. "This Psalm has been my spur since I heard Fr. Giussani recite it in St. Peter's Square on May 30, 1998. We nurses are called by our profession to take care of people; but how do we live this responsibility? In today's situation, the first striking thing is the substitution of two terms: the patient has become the user, the hospital the firm. The nursing profession, born as a calling to serve man, has been reduced to technical proficiency; we are health technicians, who must provide quality service to customers who pay. We can no longer conceive of ourselves as persons helping other people, but as machines trained to perform standardized movements. The proof is the way nursing students are trained; they know how to use sophisticated instruments with precision, but they don't know how to stay beside a dying man."
The problem, then, is the loneliness and the individual way in which this work is lived. Service is rarely perceived as a responsibility shared by everyone. "Patience, sharing, pardon," Giovanna went on, "are terms that have been banished as a dimension of the profession. This is translated into living the job full of complaints, stressed out, and with little extra to give beyond what is required."
Placing the accent on the problem of training, Cecilia Sironi, a nursing teacher, reviewed the 15 years of her experience. "As the years passed, being a good nurse, even though I liked it, was not enough for me any more. I sensed that teaching this profession might have been more useful. So I went back to school, and once I finished my studies, I accepted the risk of opening, directing, and teaching in a nursing school. Over the years, I have focused on trying to approach professional and educational reality with a criterion, measuring everything against the recognized ideal of life. In giving assistance, as in training, the point of departure is always the person in front of us, who has our same innate need for meaning. Our professional preparation is more complete if we do not lose sight of the human competence that is the fruit of our own being."

Doing good
and professionalism
Giorgio Vittadini, in his remarks as a meeting speaker, dwelt at length on the nature of the service profession, emphasizing its risks and stimuli. "There are two attitudes which diminish, instead, what constitutes the greatness of this profession: the idea of doing good and professionalism. The first is characterized by thinking, in Manichean terms, that the world is divided into good and bad activities. From this perspective, the service professions are a priori better than business enterprise. This causes, in those who devote themselves to helping professions, a presumption which makes you serve others by placing yourself as the center of focus, since whoever serves is 'good by definition' precisely because they put themselves with the least and the helpless. The receiver of help thus becomes an object on which to act rather than a person to embrace." This is a little like what happens in Manzoni's The Betrothed, when Don Rodrigo's successor invites Renzo and Lucia to lunch and serves them, but then eats somewhere else himself. Manzoni comments on the episode by saying that it is much easier to set oneself below someone and serve them, rather than to place oneself on the same level, being together with them.
"Professionalism," Vittadini continued, "usually follows this idea of doing good: you realize that the work is heavy and that the surge of generosity is not enough. The heart gets tired and resentment sets in. The frustration that comes of this finds an outlet in an obsessive search for new techniques, new training, different structures, and social reforms."
Vittadini then remarked how the history of Italy has been distinguished in the field of service by the testimony of religious orders that, positing Christianity as their starting point, built hospitals and medical structures. "The Fatebenefratelli, Cabrinians, Camillians carried their works into all the world, motivated by charity and the needs of others."
The meeting gave voice, among others, to the testimony of the Sisters of Charity of the Assumption, who offered to the audience an impassioned story of their mission. "Our assistance is offered in service in the home, taking care of the sick, supporting families in difficulty, assisting the elderly, the disabled, and outcasts. There is a strong component of fatigue in our work, even physical: moving from house to house, constantly changing situations, feeling the burden sometimes of being the only resource for those in front of us. How do you stand beside a person who is suffering? The force that gives us strength in fatigue is not born of an effort or attempt to be adequate to the task. It does not change things much if I say, 'I will try to love you in the name of Christ.' The source of rest is understanding that being with the other is born from the need that I have for myself and for my life, that makes me say, 'I am here in front of you who are made of Christ, which is what my heart was made for.'" This makes a reality worthy of love and charity possible.



Father Giussani's
greetings

I express to everyone-first of all to those who wanted this meeting to happen and then to those who made the sacrifice of coming-my gratitude for a testimony offered in this area of life which is so exemplary, this area of service, humble and even passionate, to persons because they depend on the Mystery which makes all things, as is documented in the experience of illness and of need, even physical.
In a time that has forgotten the value of persons as made by God-except when it celebrates their efficiency or the appearance of success-those who in their profession dedicate themselves to caring for their brothers are called, more than others, to give the freely offered example of that sharing which the life of Christ always documents, like the day when He met along the way a mother who was accompanying her son's body to the cemetery; He went up to her in sympathy and came out with that unimaginable expression, "Woman, do not weep!" And then He gave her back her son, alive, a miracle in the miracle.
Taking care of others to this point is something otherworldly, within this world. What mother can look with confidence at her child except in the perspective of his destiny? In the same way, those who turn to you for concrete help or even only for a comforting look on their pain, the sign of an eternal friendship that gives hope, must feel themselves observed like this.
For this reason, I would like to answer the question that you have asked yourselves in this way: Yes, it is still reasonable and beautiful to be a nurse, even in difficult conditions and even when underpaid.
Reasonable, because participating in the actual life of those you meet-and obedience to the circumstances that come up every day-is for you the way of doing the will of God, a God who is mysteriously intuited by those who do not believe, and recognized as present for those who have faith.
Beautiful, because nothing is more exciting than "giving one's life for one's friends," and thus sacrificing life, energy, and time so that the other can live, that is, can fulfill himself according to the breadth of his destiny which not even death can stop-and you all know something about this-since the heart of every man is made for infinity.

February 9, 2000