Dorothy Womack is a chaplain and Bible instructor at the Loma Linda Medical Center, Loma Linda, California.
The approach of death poses problems for everyone who is near a dying patient. These problems differ from person to person and some times from one day to the next. The pastor or chaplain often plays a crucial part in helping many of these persons, including the patient, to solve their problems gracefully.

From studying dying patients, Elisabeth Kubler-Ross discovered five "stages of dying." The first is denial, when the patient disbelieves the report and seeks desperately to disprove it. When the evidence overwhelms his doubt, however, he may enter the stage of anger, demanding, "Why me?" "Why now?" He may resent fate, God, or, later, even family members and professional people who are trying to help.

As his anger dies the patient may express his hope that the disease can somehow be cured, and resort to another strategy—bargaining. At this stage the patient acknowledges his condition, but seeks to postpone the inevitable. He may attempt to strike an agreement with the physician or make a solemn vow to God. Eventually he realizes that the end cannot be put off, and he may enter the stage of resignation or depression. He grieves over loss of past joys and benefits and anticipates what he will miss. He may hope most that the end will not be painful or undignified.

The final stage Dr. Kubler-Ross noted was acceptance, when the patient ceases his struggling, bargaining, and mournful thoughts and is ready to face what seems in store f or him. The patient's chief concern now may be for the welfare of his family and other survivors.

Although admitting that some patients do not go through these stages in just this order, but might skip one or more, repeat some, or experience them in another sequence, Dr. Kubler-Ross has advanced our understanding of the changing moods of the dying patient. Even nurses, family members, and the pastor or chaplain may experience changes of attitude similar to those of the patient. They too may feel shocked and disbelieving, may become angry or depressed. They may turn their backs on the angry, fault-finding patient just when he needs someone to hear him out. A nurse who will sit quietly with such a patient and hold his hand for even a few minutes each day may be of great comfort to him.

The pastor or chaplain likewise should be informed about the emotional needs of the patient and his family and the supporting healthcare staff. He must learn not to react with hostility to the fretfulness of the patient nor the apparent coldness of the family. He should learn to recognize the special needs felt by each participant in the ordeal. Even physicians and nurses may have emotional burdens resulting from the strain. The pastor or chaplain should be willing to listen patiently to all these. Or he may serve best by tactfully asking questions: "How do you think it will be with your family?" "How do you think it will be with your father?" Sometimes he must answer questions raised by the patient or family about the prognosis of the disease and be prepared to give truthful answers.

"In many cases all that should be done is to point to Christ as a personal Saviour. . . . Do not let anyone be launched into eternity without a word of warning or caution. You cannot neglect this and be a faithful steward. . . . Never, never should the physician prevaricate. It is not always safe and best to lay before the invalid the full extent of his danger. The truth may not all be spoken on all occasions, but never speak a lie." —Medical Ministry, pp. 38, 39.

When the patient and the family have put the prospects for death into perspective they may have time to arrange for financial matters and funeral services and to resolve old wrongs. Sometimes these circumstances open the way for the pastor or chaplain to help them think constructively about life and death, salvation, restitution, and the hereafter.

The pastor or chaplain who is willing to enter this arena, where the deepest anguish of people stirs up the deepest feelings in himself, may find himself becoming increasingly aware: of his own limitations. He may find the whole range of his emotions highlighted by the experience—irritability, tension, boredom, disgust, and elation. In becoming aware of these he may learn to know himself better and to achieve control over his attitudes. He then may be better qualified to reach others who are discovering what it is like to plum the depths of their emotions. By introducing the Saviour, who Himself knew suffering and death, he can help them emerge from the crisis with love and acceptance in stead of bitterness. And in One who overcame death they may find hope. Through the ministry of the pastor and the chaplain they may learn that God too listens to their cry for help.

Dorothy Womack is a chaplain and Bible instructor at the Loma Linda Medical Center, Loma Linda, California.

June 1978

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