"I don't know much about dying," drawled the cabby in the front seat,' 'but I do know I'm not afraid of it. You see, in Appalachia, where I was raised, no one ever dies alone. We do what we call 'sittin' up with.' The people you love never forsake you."
Unfortunately, this is not the experience of most of us, especially in the Western world. The reasons aren't hard to find.
We live, for the most part, in a death-denying society. Technology has reduced worldwide annihilation to the pushing of a few buttons, yet, paradoxically, our denial of death is more deeply entrenched than ever. As a result, we tend to avoid the dying and the bereaved. When a person is ill with a nonfatal disease, the nurse may have to hang a sign on his door restricting visiting. When the diagnosis is "terminal" no sign is necessary. People begin withdrawing voluntarily; even clergy have been known to reduce the frequency of their visits.
This denial of death also causes an illusion of immortality. Many people cannot bear to think about their own death. They haven't the slightest idea of what grief is like. This attitude makes coping with death very difficult. It makes grief much more painful, and also hinders people from supporting the grief-stricken.
A second factor increasing the trauma of death is the mobility and impersonality of society. Corporations transfer employees frequently; people move to obtain better jobs or more congenial climates. But this mobility, despite whatever advantages it may have, also reduces the number of intimate relation ships that support families experiencing grief. If a person has a strong network of close personal relationships prior to the loss of a loved one, the actual period of grief will be shortened. Sadly, many people have no such network by the time they have moved across the country a half-dozen times.
The high divorce rate also plays a part in disrupting the emotional balance and making it difficult to cope with a crisis. It adds to the weakening of the human support system.
Even churches have become larger and more impersonal, reflecting the society about them. Some of the important rituals surrounding death and illness are no longer practiced in the church. A group of church people may bring a meal to the home after a funeral, but weeks later they seldom visit the bereaved.
Social pressure to return quickly to normal isolates the mourner. He doesn't feel "normal," nor does he usually want to, but others expect it of him. The outward stifling of complex inner emotions can build a real blockade in the path to recovery.
I believe the church needs to improve its ministry to the dying and the grief-stricken, especially in light of prevalent attitudes regarding death. What can be done?
Reading alone does not equip you for the task, nor will it enable you to adequately enter into the feelings, fears, and needs of dying persons. The best way to learn is to spend time with the dying. This is your best textbook.
First of all, remember that dying persons are very perceptive. They can pick up and read your feelings as soon as you enter the room. If they sense you are reluctant or embarrassed to face the fact of their dying, they can conveniently deny death or refuse to talk about it in your presence.
A dying person feels an acute sense of loss. Warm, human relationships will terminate. Control over a once well-regulated life is being removed, producing a sense of lost personhood.
To a dying man or woman, feelings of being cheated and deprived are very real. He or she will not see the children or grandchildren grow up. The planned retirement won't materialize. Not only will he or she be deprived of a spouse's companionship, but the possibility of that companionship being enjoyed by another is very strong.
A sense of urgency is felt by the dying. Increased interest in spiritual matters is often noticeable. There is a great desire to make every day count.
Environment also becomes very important. Cold, clinical settings depress. The presence of children, a loving family, and green living plants bring hope. Placing the patient's bed in the living room near a window is welcomed.
One of the greatest fears of dying persons is the fear of dying alone—the fear of isolation. Isolation can occur even in the presence of a group of people if those people are afraid of their own feelings about death. It can occur when a physician deserts a patient, when nurses spend less time in the room, or when family and friends close off relationships.
Isolation increases pain, which is another great fear haunting the dying. It is the process of dying and the pain that might accompany dying mat is feared. Improved methods of alleviating pain medicinally have come to light in the hospice movement now becoming more common in the United States. The church's supportive ministry of presence to the dying needs to keep pace with the hospice approach to care. The church needs to understand that pain has physical, psychosocial, and spiritual dimensions.
Dying people know they are dying. Conspiracies of silence between physicians and families are a waste of time and a deprivation of meaningful intimacies. An old blacksmith had just received word that he had inoperable cancer. He put his face very close to mine and said, "It took a lot of courage for my boy to tell me, but I'm glad he did. I was just twelve years old when my father died in my arms. He had cancer, but he didn't know. I have felt guilty ever since. Maybe there was something he would have wanted to say or do. But he didn't know."
A growing number of researchers are pinpointing the common reactions to death—denial, anger, guilt, bargaining, depression, and numerous somatic symptoms. As dying persons experience these reactions they search for those who appear to be open enough to listen. As they are able to think through their circumstances and to freely talk of their feelings, they move toward a wholesome acceptance of death. If dying persons cannot find someone to practice "listening love," they may never accept the inevitability of death. They may deny them death or experience anger and guilt to the very end. They may die in bitter resignation.
If the church is truly an extension of the ministry of Christ, its members will learn to anticipate needs as Jesus did. In meeting the needs of the dying the church will be helping them to live fully until the time of death.
What special needs do the dying have?
They need support. Support is not urging persons to be brave; this may only increase their feelings of isolation. Support means listening in a nonjudgmental way as long as they need to talk about their loss of health and their ultimate loss of life.
They need to actualize their loss. This means that they must accept the reality of the loss intellectually and emotionally. It is understanding and feeling the loss as a real and true fact. This occurs when we permit dying persons to freely verbalize the loss.
They need to express sorrow. The expression of sorrow coming from the lips of dying persons is painful both to himself and to the listening friend. But without pain there is no healing. There must be expression of the feelings of sorrow.
They need to deal with hostility. Until this happens there can be no wholesome acceptance of death. Many people don't work through the hostility because they feel guilty about having it. If the supportive visitor can admit to having similar feelings it will make the person feel that he is not alone. Frequently I tell a person, "I used to feel so unworthy when I had hostile feelings. Now I tell God about them. I tell Him that I don't want to harbor them, and I ask Him to replace them with His peace."
They need to deal with guilt. When life comes to a close sooner than expected, there are always regrets and unfinished business. We can help a person deal with it by being present, by loving him in spite of his faults, real and imagined. Point the guilty to Jesus, who never stops loving us even when we are wayward.
They need meaningful relationships. Dying persons have feelings of lostness and aloneness that make everything seem out of focus. They experience a paralysis that prevents them from reaching out. This is where other people need to take the initiative and reach out to the brokenhearted. Treat dying persons as you do the living until death occurs. Include them in the affairs of life. Let them know that they are truly enriching your life.
You and your church can take away much of the fear of death and bring meaning into the last days of a dying person. But to do so will require that you enter the despair (and the hope) of the dying person's life.
No one ought to die alone.