To a large extent my ministry to the sick and the bereaved has been fraught with the frustration of not being able to substantially help them. But within the last several years a marked increase of benefit to both the ministered unto and the minister has been felt.
The art of ministering to the sick and the bereaved will prove to be an inexhaustible source of satisfaction if we as Christian physicians and clergymen will take advantage of every opportunity to learn from the experiences of others how to find better ways and means of helping the less fortunate.
I would like to share with you some observations made on this topic through the years, and also to point out from other sources revelations that should make our calling more successful.
There are a number of misconceptions concerning the sick. Among these are (1) that all sick persons are lonely, (2) that all sick persons are bored, (3) that all sick persons are in constant pain, (4) that all sick persons are starved for good food in the hospital. Of course, there are many who suffer from one or all of these complaints, but many do not.
Those who are ill are in the midst of stark realities to which they cannot easily blind themselves. This may, or it may not, result in self-pity. Feelings of grief are frequently a part of the experience.
There are valid reasons for one who is ill to feel a sense of loss, for he has temporarily lost most of his liberties. He may permanently lose sonic of his usefulness to society and to himself, and he is sometimes confronted with the possibility of losing life itself. He has adequate and real reason to sorrow for his losses. The understanding pastoral caller, and I include you Christian physicians in this category, will permit the patient to tell the amusing incidents, the ridiculous thoughts, and the not-so-ridiculous fears that plague him. When a person in bed laughs at himself, his mental state is secure, and the visiting physician or pastor may laugh with him, though never at him.
Some Good Rules
The pastor becomes a real physician of souls when he lets the patient tell about his frustra-
tions and the supposed agents of the frustrations. Many times the sick need someone to be both a good listener and a counselor. If the pastor listens without praise or blame, but with a deep understanding, the sick will have a real sense of fellowship and communion.
We need to prepare for meeting those who are ill. The observance of the following elementary rules will smooth the way for more effective visiting:
1. Sick people, except those extremely ill or dying, are hypersensitive to odors. Keep this in mind in your selection of food and in your choice of toilet preparations.
2. If you personally do not react to hospital sights, sounds, and odors, your visiting effectiveness will be materially increased.
3. Let the hospital help run interference for you if the patient's door is closed. After entering the room, be sure to keep the door open. If the door is already open, approach the room from the opposite side of the hall, thereby avoiding popping in and startling the patient.
4. Real interest in the patient is invaluable to the one visiting the sick. Go expecting a blessing, and you will often feel that you have gained a blessing from the one who is ill.
One of the greatest lessons on contentment and patience I ever learned was from a man whom I visited a number of times. Every joint of his body had been ravaged with rheumatoid arthritis resulting in atrophied muscles and immovable joints. He was practically unable to move himself. At the height of the active stage of his illness his wife had left him and had taken their two sons. Yet, after thirty-five years in this condition, he radiated happiness.
5. Except in rare cases, the optimum length of a hospital call should be held to not more than perhaps seven minutes. Do not wear out your welcome. Patients may be exhausted by prolonged visiting by the pastor as well as by relatives and friends.
I was asked to bring you some of the high points of a book that a doctor and a minister collaborated in writing. I highly recommend this book, The Art of Ministering to the Sick, by Richard C. Cabot, M.D., and Russell L. Dicks, B.D. (The Macmillan Company, 1936), to both the physician and the clergyman, not only for the library but also for mental digestion.
The following references, except where specifically stated, are direct quotations from this book:
"Hints for Good Medical-Clerical Teamwork
"I. Doctors are strong on facts and means; ministers on motives and ends. Hence misunderstanding is natural until they come to work together for a patient's good. Then each feels the serviceability of the other when both are sincere and competent.
"2. By the patient's or the family's mandate the doctor is as much the boss in illness as the minister is at a funeral. The doctor rightly does not want interference with his job or question of his authority within his field.
"3. If the doctor does not want the minister or is antagonistic to him the conflict will do the patient more harm than the minister's services will do him good. In the rare case of genuine malpractice and injury to the patient by the doctor, the minister can probably work through others and not get implicated.
"4. Working with the doctor with deference and under his guidance, avoids most difficulties.
"5. Where the doctor is most needed, in the acute cases and in the acute phases of chronic disease, the minister is least needed. When the minister can do most, as in chronic or 'hopeless' disease, and in convalescence, the doctor is most impotent.
"6. Don't practice psychotherapy in any technical sense (or so that the patient or the doctor knows it). Come as a friend or as a minister and not as a healer; then you will get on well with the doctors. They fear competition and interference, in church clinics or home visits.
"7. Hunt the chance to do the doctor a favor in some way connected with the sick, to praise him when he deserves it, to help out in sitting up with patients and by laboring with indigent, cross-grained, hopeless, 'uninteresting' cases. Then he will want you on other cases."—Page 51.
"The minister's opportunity in sickness is to devote himself to the growth of souls at a time when pain, sorrow, frustration and surprise, bring experiences that invite a new start in life."—Page 19.
"1. Some men suffer for their sins. They have broken the rules of health and now they are sick. They have broken the law of ethics and so they are sick of themselves. They have broken the law of the country and so the community is sick of them.
"Only a small percentage of illness can be thus explained. Much of it comes from no fault of the sufferers."—Page 103.
"2. Some men suffer because of other people's carelessness or stupidity. Automobile accidents make this dreadfully familiar. . . . But it is only fair to remember that much of the good that comes to us in affection, amusement, beauty, and comfort results not from our own deeds but from our links to other people who benefit us without intention on their part or merit on ours."—page 104.
"3. We are roused by pain to stop pain. In the human body the pain of brain disease, lung disease, bone disease, leads the physician to the spot where help can be applied. . . . Pain rouses help!"—Page 105.
"4. Mental pain is often our best guide to what has blocked our growth. It is not always punishment for sin. It shows up the stupidity that we need especially to recognize and so to conquer. Hurt feelings, disappointed hopes, the anguish of seeing a loved one suffer, the prospect of death for ourselves, train us in spiritual detachment."—Page 107.
There occasionally arises the question of when the minister should suspect insanity. Newsweek, March 2, 1953, gives this measuring stick:
"1. Does everyone treat you well?
"2. Does someone have it in for you?
"3. Has anyone watched or followed you?
"4. Does your food taste all right? (Most paranoids feel that they are being poisoned.)
"5. Does anyone affect you with electricity, X-rays, radium, or atomic energy? (Many feel that their enemies are threatening them with 'outside forces.')
"6. Does anyone tamper with your mind?
"7. Do you have powers which the average person does not have?
"8. Do people talk about you behind your back?
"9. Do you feel that you have committed an unpardonable sin? (Paranoids suffer a heavy feeling of unforgivable guilt.)
"10. Do you have strange sensations about your insides? (A common answer is, 'I have no stomach, so I can't eat.')
"11. Do you hear people talking to you?
"12. Do you see or feel strange things?"
This list of questions is presented because you certainly will be confronted with need for being aware of the fact that many people suffer from mental illness as well as physical.
Let us consider for a few moments our relationship to the sick who have been immobilized by what we commonly call a stroke. We may feel that when a person has entered into a coma he has slipped beyond the realm of consciousness. It is my opinion that this belief is misleading. Of course, it is very disconcerting to visit a patient who is in coma, read the Word of God, whisper words of encouragement into an apparently lifeless ear, and pray audibly for him—all with no response. I have been through this frustrating experience a number of times, yet I believe that such patients often hear us even though they may not be able to show any signs of recognition. Within the past year two experiences involving members of my congregation have convinced me of this. One was a teen-age girl with an aneurysm near the brain, and the other an elderly man who suffered from shock following an operation. Death seemed near, no sign of recognition was apparent, yet both told me after their recovery that they had known I was there.
Several years ago in Minnesota sixty of us clergymen were invited guests at a mental health and alcoholism clinic being conducted in a nearby State mental hospital. During one of the intermissions five of us were discussing privately a few of the things we had heard.
The pastor of a large Lutheran congregation said that he believed most persons in coma were still sound-conscious. He cited a case in his church where relatives were present in the room of one who apparently was in deep coma and near death. They were talking about the division of the estate. To the surprise of everyone, including the doctor, the patient rallied and in the morning called for his minister. He indignantly informed the pastor of the events of the past evening and told him that even though he could not move an eyelid, he had heard everything. As he listened to his loved ones divide the estate, he had determined that he would get well and "show them who would get what"!
An Adventist physician recently stated to me that during her internship she helped to care for an encephalitis patient who apparently had slipped beyond the realm of consciousness. The resident physician told her in the presence of the apparently unconscious man to forget about him because he would not live and he could no longer feel anything. But the man did live, and from that day on he had an intense dislike for the resident physician. He told the young intern that he had heard the conversation. Today that patient is in the U.S. Army.
"We must remember that the dying are often entirely conscious even though motionless and incapable of showing any response to what they hear around them. We are accustomed to judge the degree of consciousness by the patient's signs of response—words, smiles or other movements. But this habit misleads us with the very ill. They may be all there save for the power to show it. 'I'm all right but I can't talk very well,' said one patient sufferer only a few hours from the end of her earthly life. Another whom we had supposed to be entirely unconscious showed after some hours of immobility a slight twitching of his lips. With my ear close to them I just made out the word 'Water,' uttered in the faintest audible whisper. We gave it; soon after he opened his eyes, smiled and talked. 'I knew everything and heard everything,' he said, 'but I couldn't move or talk. You gave me up too soon.'
"Those words have burned into me (R.C.C.) for life two absolute imperatives for the watchers by the dying:
"First, never give up hope or the attempt to be helpful until the sufferer's heart and breathing have been silent for more than a minute. Long after you think all is over you still may be needed.
"Second, in the presence of the apparently unconscious person never say anything that you do not want him to hear. You never can tell that he is unconscious and you never can be sure how much he hears. He may be cruelly hurt when you speak or even whisper words that he is not intended to hear. This has happened several times in my experience. Two watchers, each tending the one dearest of all to him, said what they would rather have died than have overheard, found out later that it was overheard, and carried for all their remaining years the scars of that moment's agonized self-reproach.
"Say nothing, therefore, in or near the dying man's room except what you will be glad to have him hear and to remember later that he did hear. There is, we repeat, no proof that he cannot hear until heart and breathing have been long silent. Only the physician can be sure of this. Awaiting his decision all others should 'carry on' as if the sufferer were fully conscious.
"It is not enough to avoid terrible blunders in the presence of the dying. Since they may at any time be conscious and may need the very words of love and courage which we think it too late to speak, we should speak them and keep on speaking them, by faith and without any response. Whatever we should ourselves most want to hear if we were aware of approaching death but unable to make any sign of response, that we should say from time to time, not loudly but with all the meaning that we can put into our voices."—Pages 309, 310.
"To suffer is not to rebel. Suffering is a fact, not a plan or an argument. It is a part of the fact of love. If you rejoice in the presence of him you love, you are cut by his absence. Else you are as fickle and as mindless as an insect. Condemn sorrow and you condemn love at a moment when it most needs reinforcement."—Page 317.
May I share with you now some of the observations made through the years about normal and abnormal grief? You physicians meet this matter of grief often when the bereaved is in a partial state of shock. We clergymen must minister to the bereaved in the later stages of shock and as they emerge from it. There are some patterns of abnormal grief to which we should be alerted. The inspired pen speaks of "doubt, perplexity, and excessive grief, that so often sap the vital forces and induce nervous diseases of a most debilitating and distressing character."—Life Sketches, pp. 270, 271.
"Many of the diseases from which men suffer are the result of mental depression. Grief, anxiety, discontent, remorse, guilt, distrust, all tend to break down the life forces and to invite decay and death." —The Ministry of Healing, p. 241.
Grief, as a rule, is a problem for the pastor. But abnormal grief may become the physician's problem too. Time will elapse between the time of the notification of death and the full grief response. There is a normal delay. Usually the period of extreme sorrow lasts about a month, with short periods in which the grief is most intense. If you are present on these occasions, it is helpful to open windows for a good supply of oxygen, and give water to drink. Food during these days of sorrow should be well prepared and simple. Grief is a tremendous drain on both the emotional and the physical system.
You may suspect a pattern of abnormal grief if you observe the following:
1. The bereaved seems to be in a daze long after the initial period of intense grief should have subsided.
2. The withdrawal from the circle of intimate friends to seclusion.
3. The apparent deification of the deceased by the bereaved. Perhaps there is a desire that nothing should be moved that the departed left on the day of death—a tie hanging over a tie rack, a book left open to a certain spot, et cetera.
4. The bereaved begins through empathy to mimic diet, mannerisms, et cetera, of the deceased.
Other evidences might be added, but these should suffice to make us aware of the danger signs of abnormal grief.
On the other hand consider this counsel:
"Beware, then, of trying to 'cheer people up' at a time when that means faithlessness to the dead. They should be encouraged to cultivate the recollections and meditations which inevitably bring grief as well as thankfulness, reverence, and deepened love. Love can be entrenched once for all in one's life by this invaluable period of integration. Those who can share in this experience can help to revive memories of the departed or to add new outlines to the portrait then being stamped once for all on the souls of the bereaved. They will find their own affections strengthened too. Such friends will come to form a unique band of intimates joined by the possession of memories that are precious."—Page 318.
Now may I say that good pastoral care for the sick and bereaved can be provided only if the pastor (I include the physician in this category too) is properly prepared. And when the minister is adequately prepared to care for the sick and bereaved, all is to no avail unless he actually calls on them. It is only as the minister actually arrives at the bedside that his preparation can result in blessing. Such pastoral calls occasionally result in physical healings. But even if physical health is not restored, peace of soul and peace of mind can result from good pastoral care of the sick and the bereaved.
"Thou wilt keep him in perfect peace, whose mind is stayed on thee: because he trusteth in thee" (Isa. 26:3).
May God bless all the doctors and pastors as they minister at the bedside of the sick.