Pastoral Care to the Dying

Science has made us gods even before we are worthy of being men. J. Hamburger - French physician, 1939.

The Shutdown Interval

All of us live with the potential for death at any moment. All of us have a trajectory of our life, that is, we anticipate a certain life span within which we arrange our activities and plan our lives. And then abruptly we may be confronted with a crisis – the crisis of information. We learn that our trajectory betrayed us and we are given only days, weeks, perhaps a few years left in this life. Our life has been foreshortened. Our activities must be rearranged. We cannot plan for potential; we must deal with the actual. It is this period between knowledge of impending death and the point of death that creates the shutdown interval. Even if our lives are extended a year or two or ten, shutdown mode is still in operation and stays in the consciousness.

When we think in terms of cancer, kidney failure, coronary diseases and so forth, we know that they are all problems of life. Death is not, for death is not amenable to treatment or intervention. Death can only be considered an issue between God and man. But the process of death remains a part of a person's life.

How Death is Viewed

In America, death is viewed negatively. Yes, we live in a death denying culture and it is seen everywhere, especially in the hospitals, funeral homes, and the entertainment world. It is rooted in the traditions of our Judea-Christian heritage.

It is unfortunate that we live in a society where the biggest lie is perpetuated by insisting we can stay young if we follow the world's prescription; a society where we assign our elderly to live out their days in buildings by themselves so we do not have to be reminded of our future, if we live.

My mother was not perfect by any stretch of the imagination, but one of the best things she did for me and my siblings was to bring my elderly and ill aunt from Milwaukee to live with us because she could no longer care for herself and a nursing home, my mother determined, was not an option. In our culture today, this may seem like a huge burden and perhaps it was. But it was a cross my mother accepted and for me, it was Providence. It was a circumstance God used to equip me for a future mission that was to become my reason for being. How I cherish memories of those last moments with my mother's sister.

There is also, more often than we care to admit, a death desiring attitude pervasive in our culture, though not spoken of as often. Yet, this attitude prevails among many who seek release and escape from the misery of their lives.

Actually, ideal is the death accepting attitudes because it places death in perspective as a part of life and one that is integral to existence. I have witnessed many happy Christians who have reached fulfillment and look toward death as the satisfying and acceptable end to their earth life. They demonstrated the ultimate in faithful living and faithful dying.

The Dying Deep Desire

1) One of the most important observations I made of the dying, is when the dimension of a future ceases to exist, the dying desire truthfulness and clarity in human relationships. I am convinced that the greatest pain suffered by the dying is not the dying process, but rather, the inability, in many cases, of those that they love to be “present” with them. This is unfortunate for many reasons the main being these loved ones are then exempt from being a significant sojourner in the dying’s psycho-spiritual world, a world of great learning, wisdom and illumination as well as sorrow, regret and exclusion.

2) The dying prefers their transition occur in familiar surroundings. Most want to die at home and many opt for hospice services primarily for this reason. I think it is crucial for caregivers to realize that the dying attitude toward their death is influenced by their environment and the nonverbal messages those in the environment send to them. The dying desire above all to be in an environment where dignity and integrity as a person can be maintained. Please know that when it comes to subjective understanding of the dying process, the dying knows far more than caregivers, doctors or pastors. They do not become "childlike" in their minds and spirits, only in body. They desire the rights, respect and dignity they deserve by virtue of being members of the human race.

But too often, due to our own discomfort with death, the messages we send to our loved ones discourages the sharing of their feelings, thoughts and ideas. Thus, we sacrifice not only vital knowledge that would surely help us when we find ourselves at the same exit door, but the gift of love they try so desperately to give: glimpses into what the death experience feels like.

3) The majority of dying individuals are not really interested in advice, temporary solutions, or cures. This is something that is most often forced upon them by friends, family or health care professionals. What the dying prefer is simple truth, openness, and the opportunity to share the grief experience of their own dying with those they love. In other words, the deep desire is for compassionate companions who are willing to share in authentic communications, hand in hand as they walk the last mile of the way.

4) The dying are no longer interested in trivialities, pettiness, pretend behaviors and chit chats about nothing of particular meaning. At this crisis point in their existence, they seem to opt for the more authentic forms of behaviors and interactions.

Furthermore, it is difficult to keep secrets from the dying because their audio radar ability has temporarily sharpened. They can hear whispers with much clarity and hearing is the last organ to shutdown. The problem is when our actions say one thing and our words another. We are in essence lying to the dying. It is unfortunate when both the dying and the living know the truth but neither is willing to let the other know that they know.

The greatest suffering I experience in ministering to the dying is in those situations where, for whatever reasons, family members are unable or unwilling to put themselves aside to be "present" for their dying loved one.

Personal Pastoral Disclosure

I cannot begin to impress upon you the unmitigated joy one feels providing spiritual care to those for whom cure goals is no longer an option. The dying resides in a different world, a world that has been restructured and how truly blessed I am to have been allowed entry into the world of so many. I consider it a great privilege that it pleased our Lord that I should be chosen to become part of a magnificent collaborative endeavor to help those exiting time to enter eternity, achieve their goals for a personalized dying.

The last few hours

A unique quality that is particularly noticeable among the dying is that many exhibit what is known as the "death is near" syndrome. This important clue is often missed by family members and the health care providers. Sometimes, the dying may articulate in an incomprehensible way or say things that do not make sense to us. For example, I remember ministering to a young woman, who appeared to be in a daze, but she kept asking of no one in particular, to get her red shoes and bring them to her. Her family was frustrated and thought she was "talking crazy talk." I asked the patient if she was going somewhere special where she wanted to wear the shoes. She responded in the positive and said her father (deceased) told her to wear her red shoes. This was the "death is near" clue. She was leaving on her journey and wanted her family to be prepared. It was a goodbye love gift the family might have missed had I not been there to help them interpret the language of the dying. Within 8 hours of my visit, the young woman had died. And, I might add, this goodbye gift of love helped to ease this family's grief.

The dying do not learn from us, we learn from them. We need to LISTEN and EXPLORE. The conscious dying ALWAYS leads my behavior and activities during visitations. They instruct me on how to best minister to them. Every individual is different and so are their needs.

Faithful Living, Faithful Dying

Walking with the dying through the valley of the shadow of death as far as I could go, has been life affirming. Each dying person I have ministered to has been my teacher. I sat at their feet and held their frail or diseased hand as they taught me their language. I listened attentively to hundreds of dying individuals engage in a kind of intensive, introspective soul searching that the rest of humanity generally neglect. I have been by the sides of many at the moment the innate sense of imminent ceasing to be shattered the illusion that there is still time; when the understanding of the real possibility that tomorrow may not include them, is accepted. I listened to heart breaking stories that revealed strength of courage that makes for true heroes and sheros. I listened to their life stories, fears, loneliness, concern for survivors and the imminent loss of self. And I grew.

What have I learned from the dying? I learn about faithful living and faithful dying.

Precious in the sight of the LORD is the death of his saints. Psalm 116:15.