Reflections on the Empty Chair

Posted on January 1, 2003

I have a friend who keeps an unoccupied chair at his dinner table. It is there each time his family gathers for a meal and conversation, to remind them of those whose stories are more fragile than that of his family, those whose lives are lived on the margins - the outcasts, the wounded, the poor, the abused, the lonely, the weary. It is a reminder of all those whose experiences, physical health, financial status, or emotional condition have left them disenfranchised, disregarded, disgraced, disadvantaged, or discriminated against.

The race, ethnic heritage, appearance, and gender of the imagined persons who sit in the chair are not always defined. On any given night, the nature of the dinner conversation may provide a clearer picture of who should be assumed to occupy the special seat. Sometimes, however, no further attempt is made to identify the evening’s guest than to recognize that he or she represents the “have-nots,” while his family represents the “haves.” The chair serves as an immediate reminder of the commitment my friend and his family have made to try to speak in a way that will not dishonor or discredit the experiences and concerns of their dinner guest.

Imagine an unoccupied chair next to you. Even better, place one there. I have one beside me as I write. We might choose to leave the potential occupants nameless and faceless. Perhaps this would be easier. But you know who they are in your world. And I know them in mine. They are my children’s friends and playmates, my neighbors, my patients. I have placed a chair here beside me for my middle son’s fifteen-year-old buddy who lives on the street behind us with his half-sister, his inattentive and unloving grandmother, and his two frequently drunk and always delinquent uncles. It is also for the new mother who met with us one Sunday morning and shared, with tear-filled eyes, the story of her childhood, living in a tent in the woods with nine siblings, abusive parents, and little food, always trying to avoid detection by the authorities. And the chair is for the seventy-year-old man, under my care for years, who fell from a ladder, broke his neck, and now lies paralyzed in a hospital bed in the back bedroom of his very simple home behind a fast-food restaurant.

This chair is here beside me for my sons’ teammate, who shares with his mother and brother a dilapidated trailer with no electricity; for the frantic, hysterical woman who nearly exploded in my exam room while revealing that she had just learned of a long-term incestuous relationship between her husband and her daughter; and for the friend whose penetrating wails still echo in my ears as I recall telling her of the very unexpected death of her devoted sixty-year-old husband who died of a heart attack during a hospitalization for an uncomplicated pneumonia, only a few short years after he entered her deeply scarred and burdened life to rejuvenate her with joy and hope for the future.

I can see seated here beside me the young woman who correctly observed, “You don’t want to know,” when I asked her how she was able to pay her rent when her middle-aged male landlord threatened her with eviction. I can see the terrified mom whose fragile world collapsed around her with the unfolding story of her boyfriend’s repeated sexual abuse (rape) of her thirteen-year-old daughter; she would convulse in tears and groans as she found herself unable to tell the story, able only to grieve and exclaim, “It makes me want to throw up!” I can see seated here the longtime friend who went to work one morning trying to hide the bruises inflicted by her drunken husband the night before in the presence of their young children. I want to protect this space, this empty chair, for the little girl, whose father had recently been sentenced to life without parole for the sexual abuse of her older sister, Whose confusion and distress were so poignantly revealed by her question to her mother, “Mommy, I hate Daddy for what he did to Sissy; but is it okay if I love him in another way?”

I do not want to say or write anything that will discredit or dishonor the experiences and concerns of these potential guests.

Whom do you see sitting in the chair next to you?

John the Baptist’s father, Zechariah, described such individuals in his community as “those who sit in darkness and in the shadow of death” (Luke 1:79). For nine months, Zechariah’s tongue was tied. Rendered mute as a consequence of his struggle to believe the angel Gabriel’s promise of a son, the aging priest had many quiet hours in which to contemplate the words that must have echoed daily in his ears (Luke 1:13-17):

Your wife Elizabeth will bear you a son, and you will name him John. You will have joy and gladness, and many will rejoice at his birth, for he will he great in the sight of the Lord. . . . He will turn many of the people of Israel to the Lord their God. With the spirit and power of Elijah he will go before him, to turn the hearts of parents to their children, and the disobedient to the wisdom of the righteous, to make ready a people prepared for the Lord.

What must Zechariah have thought? He continued to work every day. Luke says he served “according to the custom of the priesthood” (Luke 1:9). Unable to speak, he motioned with his hands in an attempt to communicate. As long as his section was on duty, he had a job to do - but silently. Then Luke notes, “When his time of service was ended, he went to his home” (Luke 1:23). But there also he remained silent. Perhaps, for a while, Elizabeth enjoyed the break! Yet I suspect that Zechariah’s silence eventually became burdensome and wearisome for both of them.

So he probably sat often and thought deeply. Who and what will our son John grow up to become? What will make him great in God’s sight? Who will he bring about so stunning a transition in the lives of so many - parents and children reconciled, the disobedient brought to holiness, an unruly and confused people made ready for the Lord? But how?

And what kind of Messiah was Zechariah expecting? For whom would his son prepare the way? Did Zechariah share the hopes and dreams of so many of his countrymen that the Son of David would drive the Romans away? The first portion of Zechariah’s prophecy (Luke 1:69-75) suggests such visions were at least a part of his messianic hope:

God has raised up a mighty savior for us

that we would be saved from our enemies and from the hand of all who hate us

To grant that we, being rescued from the hands of our enemies, might serve him without fear, in holiness and righteousness before him all our days.

What else did Zechariah think about during those many quiet days and nights? How else did he come to understand the role his son would play in preparing the way for God’s Anointed, and how else did he conceive of whom the Messiah would be and what he would do?

Speaking of his son, Zechariah embraced the association with Elijah and proclaimed John “the prophet of the Most High,” the one “to give knowledge of salvation to his people by the forgiveness of their sin.” (VV. 76-77). Speaking of the Lord whose way John would prepare, Zechariah exclaimed, “the dawn from on high will break up on, to give light to those who sit in darkness and in the shadow of death, to guide our feet into the way of peace” (vv. 78-79).

Light in the midst of darkness. Peace in the shadow of death. Those are images not necessarily inconsistent with the ones developed in the first portion of the prophecy - a mighty savior, a delivery from the hand of all who hated the Israelites, a rescuer from their enemies. Yet the images of light and peace are additional, more complex, more penetrating, more inviting perhaps of contemplation.

Who would Zechariah have had in mind when he spoke of those sitting in darkness, or those who lived in the shadow cast by the end of life? Would Zechariah have thought only about the “lost” - the pagan nations living around Israel and the unbelieving aliens living among them? Might he have also considered the lepers disregarded outside the city’s gate or the Gentile worshipers who came to the outer court of the temple only to be ridiculed, disdained, and offended by those Israelites whose prejudice and hatred ran deep? Perhaps he also considered the widows struggling to survive, emotionally and financially; the humble, quiet teenage girl, pregnant and frightened, at risk of being cast aside by her fiance; the lame man who could not work; the poor family who gathered up the leftovers along the edges of the fields each evening?

Zechariah might have been a member of Hebrews Community Health Fellowship (HCHF) and Israelite Community Development Association (ICDA). Maybe he would have been right at home among the membership of CCHF, wrestling with the difficult issues of living out our faith among the poor as we try to attend to their - and our - physical and spiritual needs.

Zechariah might look at the empty chair next to you and immediately identify the faces and names of the people he could imagine sitting there. Can you?

Light in the midst of darkness. Peace in the shadow of death. The gospel of Jesus of Nazareth. The good news he taught. A little later in his account, Luke records Jesus’ claim to Isaiah’s prophecy (Luke 4: 18-19):

The Spirit of the Lord is upon me, because he has anointed me to bring news to the poor. He has sent me to proclaim release to the captives and recovery of sight to the blind, to let the oppressed go free, to proclaim the year of the Lord’s favor.

Oh, how I would like to do that! What an amazing physician I could be! What a powerful ministry my health center could have if I could always bear good news to the rural poor, unbind those in captivity literally or figuratively, end oppression in the hills of Appalachia, and give sight to my blind patients. I would be thrilled if I could always turn on a light for those who have chosen or been forced to sit down in a dark, cold place.

A young woman called me at the office recently, crying, repeating over and over, “I just can’t go on any longer.” In answer to my questions, she revealed that she was sitting in a dark closet with a gun at her side. I struggled, painfully and urgently, to find a way to offer some light in her life as she literally sat in darkness, in the shadow of death. What could I say that might help her find a way out of her despair; that might give her reason to hope that peace, perhaps even joy, could return to her life? Instead, I kept her on the line while my nurse called the sheriff, and then I listened to her cries of anguish and her hateful accusations when, only five minutes later, “the law” entered her apartment to carry her to the hospital for evaluation. Had I helped the light to break through into the darkness that surrounded her? Had I guided her feet into the path of peace? I don’t know. I certainly did not feel as if I had brought good news to the poor, recovery of sight to the blind, or release to the oppressed.

Light in the midst of darkness. Peace in the shadow of death. The good news of Jesus. We are part of the CCHF fellowship because we have committed to “live out [this] gospel through health care among the poor.”

Often I have dared to dream that my life, my work in Appalachia, might somehow be an expression of the prophecy Jesus lay claim to in Luke 4: preach good news, unlock prison doors, open the eyes of the blind, and speak prophetically and powerfully of the presence of God’s favor.

Usually, I just cling to the hope that my efforts might simply fall in line with the vision of Zechariah in Luke 1, that through me the rising sun might come from heaven and shine on those living in darkness and in the shadow of death and guide their feet into the path of peace.

But if I required that this hope be realized in order to do my job, I could not go to work each morning. Because most often I get to the end of my day and have to seek contentment in the knowledge that I might have prescribed a helpful medication, made the correct diagnosis, helped a young woman deliver her baby, tried to calm a troubled spirit, removed a frightening mole, inflicted as little pain as possible during the procedures I performed, defused a crisis with an angry patient or a disgruntled employee, or simply did not add to anyone’s burden that day. Sometimes that is the best I - or we - can hope for: to not make anyone’s darkness any denser, his shadows any heavier, her paths any less peaceful; that in the midst of my efforts to do something great, something worthwhile, something that matters, I not eclipse the “rising sun,” the “Dayspring”, Whose light we seek to shine and whose peace we strive to share.

Beneficence (active goodness or kindness) begins with non-maleficence (avoiding doing evil or harm). In medicine, we often say, “First, do no harm.” If you cannot help, at least do not hurt. But Jesus challenges us to do more than just avoid doing harm. His call is to follow him—to bring, proclaim, restore, and release. And Zechariah’s prophecy inspires us with the hope that we, like Jesus, can be light and peace.

This is our hope, our dream, our calling, our commitment to be, like Jesus, a Dayspring in the lives of those we serve. We are to be light and peace for them. Although I am inspired and convicted by this dream, I have a dilemma. I must return from my visions and dreams to my daily work at Dayspring Family Health Center. And if you accompanied me, I fear you wouldnot see the realization of this dream, the expression of this calling and commitment, in every patient encounter.

My eyes see me there. My heart calls me to the vision. But my feet often stay firmly planted in ”First, do no harm.” In other words, if I cannot encourage, at least I should not discourage. If I cannot enlighten, at least I should not confuse. If I cannot lift up, at least I should not put down. If I cannot heal, at least I can refrain from creating any more scars. Can I not?

Whom do you see sitting in the empty chair you have placed beside you?

For me one face, one life, one young woman will always be there. She was twenty-seven-years-old when I met her, pregnant for the fifth time, and listed as thirty-two weeks into her current pregnancy. “Small for dates” was the reason provided for the ultrasound I had been requested to perform. She had seen one of my partners for her initial examination only the week before. He discovered that her fundal height was considerably smaller than anticipated based on the date of her last menstrual period. This concern is fairly common and usually easily addressed with an ultrasound.

I found her seated on the edge of the procedure table. I turned off the lights and asked her to lie back. After taking my place on the stool between the machine and her bed, I placed a sheet over her hips and legs, tucking the edge over the top of her slacks. As I began to reposition the lower edge of her blouse just above the top of her womb so I could apply the ultrasound gel, she spoke. It was the first complete sentence she had uttered in the few moments we had been together: “I have a lot of scars.”

I did not hesitate much, if at all. I was in a hurry, still focused on completing my task and teaching the family medicine resident I had with me. I had seen abdominal scars before. Even at her young age, multiple surgeries are not uncommon. Gallbladder removal, appendectomy, exploratory surgery for pelvic pain - each leaves a fairly characteristic mark. Sometimes surgical wounds do not heal well. Unsightly scars from past surgeries are a reason for concern and embarrassment for a young woman. But they are not often of any particular clinical significance. Whatever the cosmetic result, these scars rarely merit more than a simple notation in the chart. In the brief instant after her remark, I expected little else. I was mistaken.

What I saw, faintly in the darkened room, gave me pause. Her entire abdomen was covered by a disordered maze of curved and straight lines. A bad burn, I thought. The body looks this way multiple skin grafts. I wonder if she was in an accident several years before. These are obviously old scars. They will probably make the ultrasound more difficult  due to shadowing the abnormal skin tissue, but other than that, they shouldn’t cause any problems. I resumed my preparations, covering her wounds with the ultrasound gel. Then I tried to obtain a little more information. “Were you in a car accident, or . . .”

She did not let me finish. Very matter-of-factly, without a hint of emotion, she answered much more than I had intended to ask. “My mother set me on fire when I was three.”

None of the thoughts racing through my mind seemed even remotely appropriate to speak. Faced with such a profound and personal revelation, silence seemed the only acceptable response, or at least the only one available to me at that moment. Should I have said, “I’m sorry”? Maybe I did. Whatever I might have said did little to convey what I thought and felt, did little to bring light or peace into her life. She had just cracked the doorway into a private place in her world and invited me in. Did she do so out of necessity or fear, certain that I would ask about the scars on her body? Did she want more from me - compassion, understanding, interpretation? Whatever her intent, I could offer little more than my continued presence.

I turned my attention to the baby. All the measurements were consistent with a due date about four weeks later than predicted by the last menstrual period she reported. Most likely, her periods had been irregular or her memory was inaccurate. I told her we would need to do another study in two or three weeks to more firmly resolve the question. The baby’s anatomy seemed fine. I did not identify anything else about which to be concerned.

I tried to teach the resident during the procedure, though I did not feel comfortable saying very much. Complete silence seemed even more awkward,however. Unlike most women having their first ultrasound, this young woman was not talking. However, as we neared the end of the examination, she spoke again. What she said this time was less disturbing, although just as revealing: “Can you tell the race of the baby by ultrasound?”

I thought I had heard every possible question during the five thousand ultrasounds I had done: “Is everything okay?” “What sex is the baby?” “Does it have both arms and both legs?” “Can you count the fingers and toes? Can the baby hear us?” But I had never been asked, “Can you tell the race of the baby by ultrasound?”

I said, “No, that’s not possible.” Then I asked the obvious question, “Are you not sure who the father of your baby is?”

“No, I’m not”, she answered. She was not only unsure of the identity of the father of her baby; she was unsure of his race.

As I finished the exam, we talked briefly about her experiences. She started her prenatal care late because she had been “on the road," traveling with truck drivers. She had only recently returned to her hometown. While away, she had had several sexual partners. Some had been regular users of intravenous drugs. Sorne she knew reasonably well; some she did not. She said she had no way of determining who might be the father of the child she was expecting.

As the patient closed the door behind her upon leaving, I turned to the resident. What had I taught him? What was he thinking? I tried to explain my feeble response when the patient revealed how she came to be so scarred. “In eighteen years of medical education and practice, I said, “patients have often made comments that caused my stomach to turn over from despair, anguish, disgust, shock, or grief. I remember a medical school professor warning us of such experiences and stressing the importance of suppressing our emotions in order to maintain equilibrium. I have never quite learned that skill. I usually succeed in keeping patients from sensing my alarm. But these emotions still grip me deep inside. Even so, I almost always find something to say, some open-ended question to ask to create a little space in which I can fully recover my composure. This time, I had nothing to say. Her life is so far removed from my range of experiences. I didn’t know how to respond. If my mother had . . .” My voice trailed off. He nodded silently.

“Her life is so far from my range of experiences.” I had provided an accurate but woefully inadequate assessment. Our stories could not be any more different.

“I have a lot of scars.” She had offered a succinct but sufficient, even prophetic, disclosure. Her story would always bear these scars.

God, you understand scars. You created us so that our bodies will heal, strong and healthy, but with scars. Scars that remind us of the injury, the pain, and the miracle of recovery. But scars that remain—forever. Scars that may hurt. Scars that may be numb. Scars that are often unsightly to the eye and displeasing to the touch.

Jesus was scarred. He must have fallen as a child, scraping a knee or a hand, or cutting his foot or face. But he was not burned—not by his mother. Yet he was pierced, punctured, and beaten—without cause, or at least without guilt.

You understand scars, Lord. Do you understand hers?

I don’t. I don’t even know where to begin. I’ve never been burned. Oh, there was the time I misapplied the jumper cables and burned my fingers. It hurt - a lot. But it was an accident, my fault. I was responsible. I was not three. My mother did not burn me.

What could a three year-old girl do to deserve being burned? Nothing. I know that. But does this young woman understand? Or is that another one of the scars on her story? Will she always wonder what she did, why this happened? What could have gone so wrong in her mother’s life that she could burn her child? From where does such an action, such an impulse, come?

I don’t know. Such thoughts, events, and urges are not a part of my life; they are not within the pages of my story. So I listen. I listen to the stories of others, but not always because I want to. Sometimes I listen because I have to, because I can’t escape. Sometimes I listen because I choose to, because I am drawn toward people with scars and toward their stories. Sometimes I listen because it is my duty.

Sometimes, God, I listen because I want to—but not always. I need to see for myself and be convinced that such tragedies really do happen, that the victims do not deserve such pain, and that somehow they survive. I listen. I try to understand, but I rarely succeed. I offer sympathy and search for empathy. I want to understand. Who? When? Why? How? I have so many questions, Lord. I have so few answers. So I sit silently; sometimes close, sometimes farther away. I touch the scars with my fingers, with my eyes, with my mind, with my heart . . . and they touch me. O God, may my thoughts, my eyes, my hands, my heart heal and not hurt. May they seek to understand scars and to share their burden. May I never create them.

“I have a lot of scars.” We all do. But for too many, the scars are very different, unspeakable. May we who have few scars choose and learn to be fully present with those who have so many. May we not outlive our resolve to be light in the darkness, our resolve to bring peace to those who sit in the shadow of death.

David McRay, MD, is Executive Director of the Dayspring Family Health Center in Jellico, TN, with additional clinic site: in Williamsburg, KY and Clairfield, TN. This article was first presented as a morning bible study at the May 2003 CCHF Annual Conference in Chicago. David MeRay can be contacted at dmcray [at] dayspringfhc [dot] com.

Tags: H&D, Biblical Principles, Working with the Underserved,

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