Expanding the patient's world

Are pastors just supposed to listen and pray, or is there something more we can do to help speed recovery for our hospitalized parishioners? Gerald W. Paul suggests ways to go beyond being interested to being helpful. His ideas will help you broaden and brighten the patient's outlook.

Gerald W. Paul writes from Kingston, Ontario, Canada.


John Scott, a Presbyterian minister-physician who founded the palliative care unit of St. Michael's Hospital, Toronto, says, "A visit from a clergyperson might be the equivalent of ten milligrams of morphine." Since some cancer patients get more than seven hundred milligrams every four hours, Scott doesn't give much value to a minister's visit. While translating religion into chemistry is not really possible, the statement is well worth considering.

I began my ministry with a simple motto for hospital visitation: "To love is to listen." I'd make my rounds eliciting catalogs of symptoms, oft-told tales of operations, and self-centered sagas of all the trials and pains the sick had suffered.

With a Rogerian focus on patients, and a masochistic need to listen to their tales of woe and make them monarchs for the day, I suited well the popular stereotype of clergy as passive-responsive hospital visitors.

Concentrating on my parishioner patients' needs, I learned much about gallstones and diabetes, alcoholism and drug abuse, labor pains and cesareans, strokes and heart attacks, as well as sixty-four varieties of backache, head ache, and bellyache. Allowing patients to have my ear like the wedding guest whose ears the ancient mariner grabbed, I was privileged to learn of last night's overcooked broccoli, the failure of the hospital shop to stock a preferred brand of cigarette, the nurse's glacially slow response to an overused buzzer, and how the cleaning staff made enough noise to waken the dead.

At times I'd wonder about the value to me of bits and snippets of the inside dope on emphysema, institutional meals, and idiosyncrasies of staff. But for years I never doubted the value to patients of having a chance to level with the minister. By expressing what was on their minds, I reasoned, they would be spared the heaviness of heart and sadness of soul that sooner or later descends on those who have no outlet for their feelings. Short-range pain for me meant long-range gain for them.

Reinforcing my blotterlike role in hospitals was the remembered story about the old psychiatrist telling a group of interns that the trouble with novice psychiatrists is "they abhor a silence." Not having any idea of what a clergy hospital visitor should be up to, I let the droppings of psychiatry at least give me a tongue to stand on. After initiating a conversation with "Hello, how are you feeling?"—ending with a marked rising inflection—regardless of the length of the silence or the depth of my embarrassment as I waited determinedly for a response, I held my peace.

On one occasion when there wasn't a murmur in response to my ministerial salutation, the passing seconds seemed like a thousand ages in my sight. It struck me as not unlike the fabled contest between the sun and the north wind: the patient seemed to be as determined not to respond as I was to wait for her response. At first we avoided eye con tact. Then by gradual steps, awkwardly taking turns, we moved irrevocably from glance to gaze to glare. For a while the principle of the thing held me stubbornly steadfast. But as time wore on and I thought of the other calls I had to make, I decided to settle for a saw-off. Rookielike, I made a clumsy but unmistakably military left turn. And with lips sealed, marched venerably out of the room.

In one of Kubler-Ross's articles on death and dying, I'd read that her favorite way of getting patients to talk about what really matters is to lean over the patient's bed and whisper existentially, "It must be tough, eh?" Apparently the gifted physician could evoke an avalanche of anger, drain a lagoon of loneliness, and extract a desert of depression by simply uttering those magic words.

I made the mistake of trying her incantation on my hospital rounds. While I had the question right, "It must be tough, eh?" the responses I got were of the "I'm OK, you're not OK" variety. Sentences were not only clipped ("Who, me? I get along fine, thank you") but were accompanied by threatening emphases suggesting that patients will not tolerate any insinuation that the visiting minister has the inside dope on the real condition of their body or soul.

After five years of nondirective passive responsiveness utilizing the fixed conversation starters associated with patient-centered visitation, I had enough medical knowledge to be dangerous and enough trivia to outdo the town's top gossip. But in spite of such personal gains, I kept wondering whether letting patients pull out all the stops—repeat the unrepeatable, dig up dross and call it gold, or focus on their navels, their wounds, their aches, or their incisions—had anything to do with my calling as a Christian minister. And if, for that matter, by encouraging self-indulgence and self-centeredness, perhaps my visit was making patients not better, but sicker.

Experience and reasoning led me to amend my "To love is to listen" visitor's motto to read "To love is to listen, once." Shifting from submission to taking charge, I learned to concentrate not on getting the patient to recite his troubles, his feelings, or his fears, but rather on giving him a picture of the outside world. I continued to focus on the well-being of the patient. But instead of evoking the patient's world, I brought the larger world into his life as the preferred path of healing.

As an amateur naturalist I started bringing nature into the hospital. In spring I'd wear a violet, in summer a dandelion, in autumn an aster, and in winter, when I could afford it, a rose. In my pockets I'd carry fossils from the limestone ridge, shells from the beach, maple leaves from the trees. In season, pussy willows in my hand brought beauty into the patient's world.

Instead of my listening to repeated recitals of ailments, my "show" of nature created opportunity for a "tell" of nature. As I told of May's marvelous bird migration I'd whistle like a cardinal, quack like a mallard, sing like a song sparrow. Bringing some beauty from outside into the hospital triggered reminiscence. Patients would tell me of killdeer seen in the plowed fields of the old farm, and of fence-post-loving blue birds thinning out as steel fences replaced the rails. My visits helped patients enjoy a remission from, rather than a reinforcement of, their illness. I soon became convinced that I was now doing more good than a few milligrams of morphine.

In a small town of six thousand where I ministered for six years, I used to bring not only nature but Main Street into the hospital. "Saw your friend Jim Walker in the Sunrise Restaurant. He asked about you. Sends his love." As I delivered the good news to patients that they were not forgotten by friends, they'd often talk about Jim's skill at catching trout or Wilma's run-in with a skunk in the chicken coop. As the images of others filled their minds they gained relief from the hospital hazard of self-centeredness, where one's world tends to shrink to the size of a hospital room.

While confession may be good for the soul, repetition is good for nothing. Permit patients to call the shots or set the mood, and nearly always it's a downer. By encouraging an outpouring of self-pity we reinforce the alienation of our hospitalized parishioners. It's better to take charge and bring the bigger world to the patient's smaller one. By doing this I escape the needless doldrums imposed on me every time I give a "poor, poor me" wretch the reins. The other patients in the room are spared listening ad nauseam to an account of all the terrible things their roommate's been through. And I think patients are better off when the clergy caller provides a breath of fresh air from the outside.

Another aid I bring into the hospital is poetry. I'm a firm believer in memorizing reams of verse. Before making my calls on St. Patrick's Day, for example, I review the Irish poems I've memorized through the years. When I enter a room where a patient has even a vague connection with Ireland, standing at the bed, I wish Paddy or Maureen a happy St. Pat's. Introductions completed, I run through all the verse of "Ah, Sweet Is Tipperary," and before the patient recovers from my initial burst of poetry, I strike again with "I will arise and go now, and go to Innis-free ..." When the patient tosses in a remembered line or two, we recite in concert. I feel in my "deep heart's core" that a few lines of poetry from the visitor brings more healing than a whole catalog of com plaints from the patient.

I used to stress hospital visitation as a one-to-one relationship between pastor and parishioner. How wrong I was! Adapting psychological rather than sociological assumptions makes it easy to reduce reality to "just me and you." While that kind of relationship has its place, I've come to believe that the pastor when visiting the hospital is not alone. What I'm saying is that the corporate dimension of pastoral work is by far the most important side of hospital calling. During a visit I mention other people in the Christian community— Alice in the choir, Bill on the mission committee, the Radcliffe twins baptized last week. This approach motivates the patient to ask about others, and before long we have a goodly company encircling the bed. Prayer, remembering some of the dear souls of the church, and rejoicing in the communion of saints further strengthens the tie that binds.

I hit upon a more concrete way of bringing the corporate healing community into the patients' narrowed world. In our small-town hospital there were always a few others from our church visiting their relatives or friends. When a patient had special needs I'd ask the healthy visitors to join hands around the sick patient's bed, and we'd say our prayers together. A slice of the Christian community at prayer I judged to be a richer symbol of healing and wholeness than pastor and patient having their private devotions.

Perhaps you've noticed the importance patients attach to what I call the cardboard community of support. Getwell and thinking-of-you cards are arranged on the patient's bedside table with the care of a devoted curator. Collectively the cards form a portrait gallery symbolizing the loving community of outside support.

To reinforce this sense of community I often pick up a card, read the message aloud, and add the name of the sender. After I've read a few cards, a patient usually perks up. Thinking of other caring people in the religious community liberates us from the prison of self-centeredness.

On my hospital rounds the Bible is another resource I use to expand horizons. But early in my ministry I discovered that reading from a heavy black book at a hospital bed gave patients the image not of walking out of the hospital healed, but of being carried out dead. I spent years memorizing the book of Psalms. While there are some psalms of lament and some psalms of wailing and woe, the Psalms provide choice morsels for visitation of the sick, and help the patient move from thinking of the sickness of self to pondering the providence of God. So when it seems fitting during a visit, I'll recite the twenty-fourth or 150th or eighth psalm, along with a small serving of the first lines of a variety of psalms directing our attention away from self and to the Lord.

Rearrangement of other Scripture passages into a medley of the faith is within every minister's power. "In the beginning God created the heavens and the earth." "'You shall love the Lord your God with all your heart,'" "They who wait for the Lord shall renew their strength." " 'Hear this, O Job; stop and consider the wondrous works of God.'" '"For God so loved the world that he gave his only Son.'" "'Behold, I make all things new.'" *

The focus of the Scripture selections I recite for patients is not Mary's gall-bladder or Jim's bicuspid valve, but God's guiding, guarding, governing providence. While there are times when the religious experience of the patient should be mentioned, I usually place the emphasis not on the patient, but on the greatness and goodness of God. The big Scripture themes with God occupying the center of the stage constitute the healing word of God. Contemplating the God who creates, sustains, and saves draws patients out of inner space into cosmic space, out of their small selves into God's wondrous world.

Patients, because of their confinement, often equate their present experience with the whole of experience. The poem "Bird Thoughts" illustrates what I mean. A robin in an egg sees the world as shell. Hatched in a nest, it sees the world as straw. Trying its wings, it sees the world as leaves. So patients, by equating their small slice of reality with the whole of reality, shrink God's world to the dimensions of "my pain, in my bed, in this hospital, now." If I can enlarge the patient's world I will help him become recovery ready. Open to a larger view of reality, my parishioner is able to respond to God's grace and healing power.

Time seems to stand still for the long-term patient. Confinement freezes clock and calendar. So I bring to such patients reminders of the seasons. Instead of sprucing up in the lobby, I visit with trench coat dripping, snow on my toque, windswept hair, and sunglasses in place. It's important to provide living imagery of passages—to show that time goes by, that we don't get to go around again, that it's now or never. That if it's the will to live that's missing, it's essential to act now to pull oneself together, to "take up one's bed" and walk. My seasonal symbols make patients weather-wise, bringing them out of the deadly timelessness that mummifies the sick, into the dynamic rhythm of the outside world.

Although explicit theologizing with patients is taboo among the devotees of pastoral psychology, I've found that introducing theological discussion has much more therapeutic value than eliciting symptom recitation. For years I visited John, a mechanic stricken with MS that finally took his life. We talked about the role of God in suffering. While we started with his suffering, we quickly moved beyond his particular question to general theological questions concerning human suffering and the nature of God. We wondered why some people strike out on fastballs, and others on curves, and what makes one person give up but another perk up when times get tough. We didn't come up with back-of-the-book answers. But accepting that there are no answers to some big questions, we discovered that the questioning is part of the answer. By talking about the really big questions we ended up feeling quite a bit better about ourselves and a lot better about God and God's world.

Before John died we put on a cassette what we'd learned together: that gentleness of spirit can persist in spite of harshness of existence; that there is more hope in the lives of the sick than in the lives of the healthy; and that a successful life can be lived in spite of what life hands us—providing we have a bigger view of the universe than our sick selves.

In stressing the expansion of the patient's world as a means of escaping from the hospital cage into the big, beautiful world, I discovered I could sometimes stimulate patients to summon from their own experience a wider world of healing connections. When an old beekeeper started to serialize his stings, I injected the line "All the breath and the bloom of the year in the bag of one bee." He immediately launched, with obvious pleasure, into a biography of the bee, touched with traces of wonder and awe akin to religion. In my judgment, my time with the beekeeper was well spent. I was doing what a hospital visitor should do: enlarging the patient's world by making the connection with nature, other people, and God.

Although I still have some doubts about my effectiveness as a hospital visitor, since shifting my focus from the patient's diminutive hospitalized world to the living, expansive outside world, I feel I'm throwing my weight on the side of healing and hope rather than pity and despair. While physicians, nurses, cooks, technicians, and other hospital workers focus on the patients and rein force their sense of helplessness, I focus on the outside world of connections with people, places, and ideas. In doing so I help counteract the centripetal force at work in hospitals with my centrifugal approach to patient-parishioner.

So bye-bye, Carl Rogers and Kubler-Ross. It's been good to know you, but I've got to be rolling along. No more shall I close the door and pull the curtain to set the stage for one-to-one counseling. I'll keep on connecting the patients' small slice of reality with the bigger vision of nature, others, and God. As bridge rather than blotter, my visits will continue to be more vital, more helpful, more theological, and last but not least, more fun.

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Gerald W. Paul writes from Kingston, Ontario, Canada.

November 1984

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