Thursday, February 28, 2013

Six Forms of Selfishness

·  Self-focus: I start to lose interest in a conversation that's not about me or in a story that I'm not telling.
·  Self-glorification: I do what I do to make a name for myself, to get noticed, to get recognition, or to be seen as someone important.
·  Self-obsession: My internal dialogue is all about me. How do I look? How do I feel? What should I do? Why didn't so-and-so acknowledge me? 
·  Self-rule: Me determining the rules of my life, silently or not so silently demanding that others keep my commandments.
·  Self-righteousness: Not thinking that I'm better than others in the traditional sense of the term, but looking down my nose at people who don't realize they're bad like me.
·  Self-reliance: Living as if I don't need divine intervention to do life, which especially manifests itself in pockets of prayerlessness.

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Tuesday, February 26, 2013

Why Medical Bills are Killing Us

From Time, by Steven Brill, and this set of clips from Josh Wooden … and we need to have a good conversation about the issues raised in this article:

Why are costs so high? We all have some crazy stories about some medical item or procedure. When I had shoulder surgery, about a decade ago, I asked the kind woman at the counter when I was paying the bill why the extreme prices — to which she said matter of factly in a kind of “Here’s why, honey!” set of statements: “This is how much your doctor got; this is how much we got; and this is how much is left over to pay for those who don’t have insurance and can’t afford the same procedure. Next question?”
“When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.

Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.
Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.

According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart.

The Bureau of Labor Statistics projects that 10 of the 20 occupations that will grow the fastest in the U.S. by 2020 are related to health care. America’s largest city may be commonly thought of as the world’s financial-services capital, but of New York’s 18 largest private employers, eight are hospitals and four are banks. Employing all those people in the cause of curing the sick is, of course, not anything to be ashamed of. But the drag on our overall economy that comes with taxpayers, employers and consumers spending so much more than is spent in any other country for the same product is unsustainable. Health care is eating away at our economy and our treasury.

The health care industry seems to have the will and the means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

When you crunch data compiled by McKinsey and other researchers, the big picture looks like this: We’re likely to spend $2.8 trillion this year on health care. That $2.8 trillion is likely to be $750 billion, or 27%, more than we would spend if we spent the same per capita as other developed countries, even after adjusting for the relatively high per capita income in the U.S. vs. those other countries. Of the total $2.8 trillion that will be spent on health care, about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program, which provides care for the poor. That $800 billion, which keeps rising far faster than inflation and the gross domestic product, is what’s driving the federal deficit. The other $2 trillion will be paid mostly by private health-insurance companies and individuals who have no insurance or who will pay some portion of the bills covered by their insurance. This is what’s increasingly burdening businesses that pay for their employees’ health insurance and forcing individuals to pay so much in out-of-pocket expenses.

Breaking these trillions down into real bills going to real patients cuts through the ideological debate over health care policy. By dissecting the bills that people like Sean Recchi face, we can see exactly how and why we are overspending, where the money is going and how to get it back. We just have to follow the money.”

Who is the Prodigal God, What is his Prodigal Mission, and How Can We become His Prodigal People? (4)

          The first four signposts F & H identify for our search for a prodigal Christianity deal with a journey into the life of the missional triune God – our context, God’s mission, missional Jesus, and missional witness.  How we make this journey is the subject of the next three signposts:  scripture, gospel, and church.

          Signpost Five takes on the contentious issue of scripture.  F & H begin to develop a new approach in line with the narrative and missional theology they deem integral to prodigal Christianity.  Scripture, contrary to the tenor of much biblical study in the last three hundred years, is a source/resource for our journey that we cannot control but must proclaim and live.  No matter how closely we read the text and grasp its language and teaching in detail, the text never becomes an object we can domesticate and (worse) use for our own purposes.  Rather scripture, God’s Word, remains irreducible subject, a sovereign Word to us that we must “hear” (in the sense of the Hebrew shama which means both to hear and to heed). 

          That raises the vexing matter of authority.  Does the authority of the Bible lie in its inspired propositions of truth?  Or its historical accuracy?  Or ethical rules?  None of these according to F & H.  Rather, they locate scripture’s authority within the story of the missional prodigality of God.  No other approach allows this divine prodigality to show through it.

          Within this story and its articulation of God working out his purposes through Adam, Israel, Jesus, and the church God’s authority is manifest in his “authoring” (my word, not F & H’s) of people through whom he will bless the world.  They write, “If the authority of scripture becomes disconnected from God’s mission in the world, it becomes disconnected from God. It becomes a disincarnate collection of facts or feelings, lacking the ability to participate and extend the incarnation of God.” (2588-2590)

          The Spirit uses the scripture to confront each of us with the claim of God on and over us to be a part of the people through he intends to bless the world.  It becomes a book whose story both looks ahead, looks at, looks back at the story’s (and the world’s) main and supreme character, Jesus Christ.  His call for our participation in the ongoing movement of his story carries the authority of his own enactment and embodiment of God’s prodigal mission.  Thus, “we should rarely find ourselves defending the Bible’s authority. Rather, its authority becomes undeniable when its compelling reality becomes visible among us. The story of God as displayed in a people speaks for itself.” (2645-2647)

          Granted the importance and centrality of this story, they turn in the next signpost to its contents and impact.

           Signpost Six delves into the gospel as the answer to the “so what” question about the biblical story.  What does this story “do” to set right the mess we have made, heal our hurts, resolve our inner and intra-personal difficulties, deal with our sin and guilt?

          Since Martin Luther’s question “Where can I find a gracious God?” as he wrestled with his guilt for failure to please God in the 16th century, we in the west have worked within that framework.  However, the questions we struggle with have changed, especially in the last hundred years or so.  The great question of the 20th century was “Where can I find a gracious neighbor?” while in the early years of the 21st century it seems to be “Where can I find a gracious church?”  The gospel that effectively addressed the question of the 16th century, and remains a vital part of any biblical version of the gospel, has not effectively addressed these changing questions.  F & H conclude:

“But the prodigal God chooses to enter recklessly into the sin and struggles of our everyday lives. The Son does not come as a distant judge, but as one who is reestablishing a kingdom of renewal, reconciliation, and blessing. The gospel that only addresses a person’s guilt before a detached God is not prodigal enough. The entire person, the entire human existence, is being renewed in what God has done in Jesus Christ. (2796-2799)

In responding to these changing questions theologians and missiologists have recovered the centrality and importance of the “kingdom of God.”  Central to Jesus’ proclamation, and indeed, the entire biblical story, this reality had too lost or reduced to the inner life of the individual under God for much of the history of the church in the west.  Biblical scholars rediscovered it in the early 20th century and theologians and missiologists built on that rediscovery to find the shape of biblical, gospel, answers to our search for God’s peace and healing in spheres beyond the personal.

As with every swing of the pendulum, the reaction often goes too far in the other direction.  This may well have happened with the use of the kingdom of God by emerging church leaders such a Brian McLaren and Tony Jones.  The cross, as a symbol of Jesus’ death for the forgiveness of sins, and the kingdom, as a symbol of God’s intention to birth a new humanity and new creation of reconciliation and justice, get separated and are liable to be played off against each other.  But according to F & H this is a fatal error:

“the cross has been ignored as the place where God’s final victory is accomplished. The prodigal gospel (of the Son sent into the far country) affirms God’s victory in the cross and the resurrection as the inauguration of the kingdom, new creation, a kingdom of love and justice. Here, on the cross, God has definitively dealt with sin in such a way that not only are our sins forgiven but the power of sin and death has been overcome. The gospel holds together both the cross and the kingdom.” (2836-2839)

The gospel in thrall to 16th century questions of personal sin and guilt constructs it presentation of it in the form of God’s love of us, our sin problem, and Jesus’ death to resolve that problem.  A more kingdom-focused view of the gospel runs (based on 1 Cor.15:1-5) the death of Jesus, his burial, and his resurrection and appearances.  In other words, the gospel is not a “plan of salvation” centered in the individual’s need for forgiveness, but a “story of salvation” centered in Jesus’ work for us and world and how through him and his work “God has become King” (N.T. Wright) over all creation.

“The gospel is the good news that in Jesus, God has fulfilled the story of Israel for the nations. God is now reigning over the whole world, making the world right. In the victory of the cross, he now rules over all sin, death, and evil. Wherever his rule is extended, the world is reordered and restored. In Christ, the promised blessings through Israel are now making their way to all nations. And in this way, God is making all things right.” (2927-2929)        

This answers the “so what” question posed to the gospel above.  This is what God has done through Jesus Christ and is doing through Jesus’ people and in the world at large in the power of the Holy Spirit.

If this is the gospel, this story of salvation, how do we share it and invite others to come to Christ?  Clearly, the “plan of salvation” approach most of grew up with is too small and finally misleading on this point.  But, as F & H confess, this is no simple task.  We’re on new ground here.  They write, “We should be asking something like, ‘Have you entered the salvation already begun in Jesus Christ that God is working for the sake of the whole world?’” (2934-2935)  While certainly some refinement is needed here, I believe they are on the right track.  I’ll have more to say about this in the review post which will be the last post in this series.

Growing out of a lengthy process of listening and discernment in their church, F &H report the four “on-ramps to the kingdom” they discovered for this church in Chicago: 

-“God is reconciling you in all your relationships”  

-“God is at work”

-“God has put the power of sin to death and is calling you into life”

-“God is calling you into mission”

          In this way their church seeks to announce, enact, and embody the multifaceted gospel found in the biblical story.  These four on-ramps give them a way to address the many concerns they encounter without lapsing into a reductionist gospel or becoming simply one more social service agency in the city.

          The first set of signposts on life in the triune God culminated in the fourth signpost of witness – a total way of life oriented to and animated by the prodigal love of the prodigal God seeking and saving his world.  The second set of signposts culminates with the church, the community in which alone this way of life can be lived in a way that gives our witness credibility and marks a space in which the God who has journeyed to the far country may be encountered.

          Once more the reduced “gospel” we met in the last signpost plays us false.  As F & H see it,

“The gospel becomes about individual status before God, witness becomes limited to verbal proclamation, and the church becomes a collection of individuals who can get the right information about salvation in order to believe and follow. These believers then have a job to do: give this information about salvation to others. God’s mission becomes something we do. The gospel becomes secret information. This approach to gospel, Scripture, and mission sequesters the kingdom of God to the interiority of our hearts. It can quickly turn defensive because it is based on knowing the right information. And because this Christianity focuses on our personal status with God, it can devolve into “being about me” and become narcissistic.” (3141-3146)

                   On the other hand, many who have turned toward a more holistic gospel of social transformation run a danger of another sort.  F & H explain:

“People like McLaren and Jones push us toward an understanding of God’s kingdom that looks for its presence beyond the church. But it is hard to tell just how Jesus would or should make a difference outside the church. Has the church merely become another social service institution amid the many others in the world? And if it has, how do people like Austin and his volunteers keep from burning out as they try to do some good in the world? How do we keep such an institution from becoming just another thing we do? This kind of church, we fear, becomes a “kind of spiritual gas station from which all and sundry [can] draw energy for a great variety of worthwhile projects.” And it eventually runs out of gas.” (3182-3188)

The problem here is another version of separating the cross and the kingdom.  The authors claim that in McLaren’s vision of the cross there is no victory over evil, sin, and death, rather it is a consequence of living faithfully in a violent world.  Jones, for his part, turns to the “God everywhere” strategy, critiqued in an earlier signpost, and fails to show how God is at work “everywhere” thus hindering the incarnational thrust of prodigal Christianity.

Another pair of well-known authors Michael Frost and Alan Hirsch are applauded for the main thrust of their work in missional directions.  However, F & H find an individualizing tendency in them.  The individual needs a fresh encounter with the living Christ to catalyze for mission.  But apart from the church and its practices, how do we know “the living Christ” when we meet him?

In each of these positions a robust, prodigal church is missing.  F & H summarize their view like this:  “The church is nothing if not local, incarnational communities practicing the kingdom.” (3258-3259)  They hold the church, the kingdom, the incarnational, and the communal together is ways appropriate to both the scripture and the gospel and that impel churches into prodigal missional practice.

New churches, they claim, ought to be started around the fundamental practices of the church, not programs.  “These practices shape a community of people into his kingdom within a neighborhood and enable us to come together and submit ourselves to the reign of Christ in any context.” (3262-3263) Indeed, it is through such practices that we meet Christ and are nurtured by him into becoming a church. 

Such time-honored practices, the Lord’s Table, proclaiming the gospel, reconciliation, being “with” the least of these, being “with” children, the fivefold ministry, and kingdom prayer, have marked genuine missional engagement with the world throughout the churches history.  Our authors claim that

“These six practices, together with the Lord’s Table and the founding practice of baptism, shape our life together in neighborhoods. . . This not a shapeless church that joins in with whatever is going on in the world. It is a church that extends the presence of Christ from the times we gather in worship, to the times we gather in our homes, to the everyday interactions we have in the neighborhood. This is the church that extends the in-breaking kingdom: the prodigal church.” (3428-3433)

If they are right, and I believe they are, one can only hope that we will listen to them!

Monday, February 25, 2013

Being Enough: Shame and Cultures of Scarcity

Last week in my post Good Enough I argued that our cultural success ethos is based upon a lie, a delusional anthropology, a false conception of who we are. Specifically, I argued that our success ethos presumes that we are gods rather than finite creatures. The success ethos--believing we are gods--presumes that we have inexhaustible resources of time, energy and talent that can be leveraged into greater and greater success, improvement, betterment, and excellence.

But we aren't gods and we don't have inexhaustible resources. We are finite. We have limits. Only so much energy. Only so many hours in the day.

But still the call for more, more, more. Better, better, better. And as I argued last week, the only way for a finite creature to give more, more, more or get better, better, better is to make greater and greater sacrifices. To spread the butter a little more thinly. Maybe it is family that is sacrificed. Maybe it's your health. Or sleep. But in the end something is going to suffer or break if we, as finite creatures, keep pretending that we are gods.

After writing that post a few months ago I started reading Brené Brown's new book Daring Greatly. You may know Brown from her TED talks. Her talks about vulnerability and shame have become two of the most popular TED talks of all time. Highly recommended if you've not seen them.

In Daring Greatly Brown makes an argument very similar to the one I made last week. Brown is an expert in shame and at the start of Daring Greatly she tries to get to the root of the problem. Why are so many of us struggling with shame and feelings of worthlessness?

Brown argues that we are living in what she calls a "culture of scarcity." For example, she asks participants in her studies to answer the question: "What do you hear or see in the phrase: Never ________ enough." Brown writes:
It only takes a few seconds before people fill in the blanks with their own tapes:
  • Never good enough
  • Never perfect enough
  • Never thin enough
  • Never powerful enough
  • Never smart enough
  • Never certain enough
  • Never safe enough
  • Never extraordinary enough
She concludes: "We get scarcity because we live it." There is never enough. Brown goes on to elaborate:
Scarcity is the "never enough" problem. The word scarce is from the Old Norman French scars, meaning "restricted in quantity" (c. 1300). Scarcity thrives in a culture where everyone is hyperaware of lack. Everything from safety and love to money and resources feels restricted and lacking. We spend inordinate amounts of time calculating how much we have, want, and don't have, and how much everyone else has, needs, and wants.
What is the source of this experience of lack? Brown traces it back to the very things I was describing last week:
What makes the constant assessing and comparing so self-defeating is that we are often comparing our lives, our marriages, our families, and our communities to unattainable, media-driven visions of perfection, or we're holding up our reality against our own fictional account of how great someone else has it.
Driven by these lies--"visions of perfection," "fictional accounts"--we create what Brown calls a "shame-prone culture" where many within the culture struggle with feelings of worthiness, feelings rooted in feeling a failure, feeling not good enough.

So how to address the problem? Brown argues that the solution isn't to replace scarcity with abundance. Again, as I argued last week, that just plays back into the delusions of the culture, that we are living in Eden, as god-like beings with a cornucopia of resources. Brown argues that the solution to scarcity isn't abundance but enough. "Knowing," as Brown writes, "that I am enough."

But to be "enough" is to to become vulnerable, to expose our weakness, insecurities, and failures to ourselves and others. To be vulnerable is to stop living the lie of god-like perfection and to stop maintaining that illusion before the eyes of others.

But that is difficult and fearful thing to do in our shame-prone culture where god-like delusions of excellence and perfection rule. As I argued last week, we are fearful of exposing our finitude to ourselves and others. Brown roots these fears in shame. Building upon the word of Ernest Becker, I tend to root the anxiety and shame in more foundational mortality fears, as a symptom of our slavery to the fear of death:
Hebrews 2.14-15:
Since the children have flesh and blood, he too shared in their humanity so that by his death he might break the power of him who holds the power of death—that is, the devil—and free those who all their lives were held in slavery by their fear of death.
Regardless, both Brown and I agree that the solution to all this is learning to be a vulnerable human being. Learning to overcome shame by embracing our failures and limitations.

Learning to say that being a human being is good enough.

Did Walker Percy Really Write the Last Self-Help Book?
February 24, 2013, 9:20 AM

So lots of readers (about six) have written ME asking for advice on what book they should read to turn their lives around.

Here's my recommendation:  Lost in the Cosmos by the philosopher-physician-novelist Walker Percy.  It was published in 1983, and I'm one of the very few Americans celebrating the book's 30th anniversary.  Several posts will be required to lay out even the basics about being lost in the cosmos.  This, of course, is the first.

Percy’s Lost in the Cosmos is subtitled “The Last Self-Book.”  He said he gave the book that title so that it would end up in the self-help section of bookstores.  And it did.

From Percy’s view, our bookstores are mostly filled with two kinds of books—self-help books and diverting or entertaining books about scandal-ridden law firms or extraterrestrials or VAMPIRES or a bunch of  sexually obsessive shades of grey.  Diversions, of course, get your mind off yourself, relieve your stress, help out in alleviating your fears, your anxieties, your boredom.  According to Pascal, most of our lives are diversions, escapes from what we really know, evidence of our misery without God.  According to Percy, most of our lives these days are diversions that become progressively more disappointing.  The pursuit of happiness has become the pursuit of diversion in the midst of prosperity.  And one problem among many about living in our highly self-conscious time is that diversions we know are merely diversions are boring or only very weak and evaporating antidotes to despair.  That’s why Percy knew people visiting museums are mostly ineffectively fending off despondency.  That’s also why highly educated bourgeois Americans today try so hard and fail so miserably in being bohemians too.

Percy adds that the self-help books are diversions too.  They claim to use the latest studies to tell us who we are and what we’re supposed to do.  They tell us that we need, say, seven habits to be highly effective, to be productive, to satisfy our basically material needs.  We are, like the other animals, organisms in environments, and we can be happy if we’re think for ourselves, listen to the experts, stay safe or avoid all the risk factors, are rich, and have effective interpersonal dynamics.  But lots of us, Percy observes, faithfully follow the self-help advice and end up feeling more disoriented or displaced or more empty than ever. All the self-help experts can add is to stay busy (but with stress-relieving periods of recreation) and positive so eventually things will turn around for you.

So the self-help books work well for a while but eventually fail, as all diversions do.  They claim to but do not really tell us who we are and what we’re supposed to do.   They can’t extinguish the experiences of self-consciousness or the self or soul by denying that what’s distinctively human about each of us really exists.  They can’t take out what the existentialists, such as the philosopher Heidegger, truthfully describe.  We’re not organisms in an environment, and so we can’t really lose ourselves—our personal identities—in some environment, in some COSMOS in which each of us is merely a part. We can’t lose BEING LOST.  That’s why the master psychologist Aleksandr Solzhenitsyn heard just beneath the surface of all our happy-talk pragmatism the howl of existentialism.

For Percy, the resulting ANXIETY—the experience of being an inexplicable or absurd leftover in the world the EXPERTS describe—ought to be a prelude to WONDER about how strange the human self or soul is.  But for the experts, anxiety that has no environmental cause (such as being isolated from the other social animals) must have a physical or chemical cause.  So there must be a physical or chemical remedy—a mood-altering or mood-elevating drug.  As Percy explains, for our experts psyche-iatry—discovering who we are and what we’re supposed to do through attentive conversation—is replaced by a kind of chemo-therapy. For Percy, Socrates and Freud were old-fashioned doctors of the soul;  the expert objection to their approach is that was time-consuming and expensive and the results uncertain or unreliable.  Who cares about the so-called REAL CAUSE if we can effectively manage the SYMPTOMS?   Why shouldn’t we CHOOSE the moods that make us upbeat and productive?

Self-consciousness doesn’t become the enemy, but something to be controlled or managed through technology.  But the truth is that even the drugs or chemo-therapy don’t work better than diversions.  It’s easy to zap self-consciousness out of existence, but that would make the zappers the masters and the zapped the slaves. The zappers, as a result, would be more miserably lonely than ever.  And, in our irrational pride and our love, we don’t really want to surrender our personal identities.  We want to be able to manage our self-consciousness the way we can techno-control everything else.  But our experts don’t really know what engineered mood or judicious mixture of moods would really make us happy or at home.  It turns out that our moods—the moods we’ve been given by nature—are indispensable clues to the truth about who we are and what we’re supposed to do.  That’s why Percy says, against the cheomotherapists, that he has a right to his anxiety.  It’s his right to liberty that might lead to real truth and real happiness.

The other self-help books can’t tell each of us why we have that right, because they don’t even admit each of us is invincibly LOST IN THE COSMOS without help we can’t possibly provide for ourselves.  We’re born to trouble as the sparks fly upward.  Our alienation doesn’t have an environmental or physical or political or Historical cause; it's part of and caused by our self-consciousness or personal identity.  It’s at the core of our REAL psychology.

So every self-help book has been a failure until Percy’s.  His is the first truthful and effective self-help book.  For that reason, it’s also the last self-help book.  Percy explains, quite scientifically, why each of us is homeless, and, by so doing, he helps us be at home with our homelessness, and so free to be as at home as we can be with the good things of this world. 
Stay tuned.  There's a lot more to come.