Life at its darkest!

The pastor's ministry to the dying

Robert L. Veninga, Ph.D., author of four books on grief and stress management, is a professor in the School of Public Health at the University of Minnesota.

It's a wake-up call for American clergymen." So concluded pollster George Gallup after a recent poll of 1,200 adults revealed that most Americans want spiritual comfort in their final days, but only one-third believed that members of the clergy would be helpful in providing it.

Now the questions are: How can ministers help those who are dying? How can they provide comfort when life is at its darkest?

Here are four areas of concentration. All of them have been suggested by patients who themselves have faced death and interacted with clergy at the same time.

Talk about death

When pastors avoid talking about death, most patients are puzzled. "We have a wonderful pastor," said an 86- year-old man. "He visits me every week. He prays with me. But for some reason, he doesn't acknowledge the seriousness of my situation." A female patient, age 47, stated, "I have a wonderful priest. But when he comes to visit, we seldom talk about what is important. We talk about the Minnesota Twins baseball team, and we talk about people in the parish. But we never talk about my death." After a long pause she continued, "I know I'm dying. Aren't priests supposed to talk about these things?"

Yes, clergy should be able to talk about death. Yet, frequently they don't. Why? Clergy may not be aware of the gravity of a patient's medical condition, particularly if the patient is not in a hospice. But even if they are aware, they may prefer to communicate about pleasant things, hoping the patient's spirit will be lifted by their presence.

I say this with some feeling: Patients believe that their pastor will help them to understand and come to terms with death. Therefore it is important that ministers converse with patients about their death.

How is this to be done? Questions such as, "What has your physician told you about your illness?" or "Do you feel that you will get better?" are soft ways of getting at hard issues. In other in stances it is best to be direct and ask whether they would like to talk about death. A pastor who is very effective in ministering to the dying put it this way: "When I bring up the subject of death, it is uncomfortable. But most people respond positively. They ask questions, and I listen carefully. I never rush these conversations, because I know that we'll be talking about the most tender part of their lives. When I leave, there is a new, deep bond between us."

As Elton Mayo, M.D., once ob served: "One friend, one person who is truly understanding and who takes the trouble to listen to us as we consider our problem, can change our whole outlook on the world." 1

Talk about regrets

It may seem strange to focus on regrets, but it is important. I once asked a 44-year-old man dying from lymph cancer, "Do you have regrets?" "Quite a few," he replied. "I never made much of my life."

"Have you ever talked about your regrets with someone you trust?" I inquired. "No, I've always been too ashamed" was his response.

Fortunately, he was able to talk about his regrets with a hospital chap lain who brought understanding and comfort. This much is true: Most people come to the end of their life with regrets, or what might be termed "unfinished business."

What constitutes "unfinished business"? I first heard the following description when interviewing a nurse who had over twenty-two years of experience in hospice care. "The one thing I have learned is that there is an 'easy' death and a 'hard' death," she said. "When people die 'hard,' they struggle. And when people die 'easy,' they have their unfinished business completed."

"What is the unfinished business that needs attention?" I asked.

"It varies from one patient to an other," she said. "Some need to see that their lives have been a success even if there was failure. Some need to resolve anger toward a parent, a child, or an unfortunate happening. And sometimes the unfinished business is simply letting go of the anger they feel toward their illness."

The nurse then told me of a man who was brought to the hospice one day before his sixty-first birthday. "When Bill was admitted, I sensed his anger. He was hostile, abrupt, and very restless. When he fell asleep he would moan as if something terribly wrong had happened. Sol asked him if everything was OK. It was then that I knew he had some unfinished business that needed to be completed if he were to die an easy death. His physical signs were rapidly deteriorating. But he wouldn't die. He wouldn't let go. It was as if there was something deep within him that would not permit death. I talked to his son: 'Something very deep is bothering your dad. I don't know what it is. Unless it is resolved, your father will never die in peace.' His son's eyes filled with tears. The family secret was about to be told. 'I have a sister who lives in Baltimore, Maryland. My dad disowned her nine years ago because she married someone of another race. From his point of view, she committed the unpardonable sin. He said he would never forgive her.' When I heard that confession, I knew what his unfinished business was all about. I told the son to call his sister and tell her to get to Minneapolis as fast as possible.

"Five hours later she arrived. I went with the son and daughter to their father's room. For the first time in nine years he saw his daughter. He said nothing, just stared at her. Then he opened his arms to his daughter and, with all the strength that was left in that frail body, he hugged her. She brushed away his tears and sat on the bed. They said nothing for the longest time. Finally he looked into her eyes and said two words that freed him forever: 'I'm sorry.' There were many tears. They held one another and talked about old times. The dad learned that he was a grandfather, and there was much laughter. I checked his vital signs later that evening, and they seemed stronger. But then an amazing thing happened. Around 10:30 that night the father said that he was very tired. But he didn't want the children to leave the room. I sensed what was about to happen and told the son and daughter to stay. Each child held one of his hands. And then he died. But his expression was serene. The bitterness was gone. Grievances had been resolved. All unfinished business put to rest."

"All of us have unfinished business," said the nurse. "You have it, and I have it. And most patients have it. It is impossible to die in peace unless the unfinished business is put to rest."2

How do we help patients resolve unfinished business? The prerequisite is to build strong, authentic relationships with the members of our congregations. We must listen with our hearts as well as our heads. Avoid judgmental comments. If we do these things, moments of vulnerability will appear moments in which patients allow us to see into their hearts. It is then that patients will confide their regrets and their hopes. It is in such a relational atmosphere that their unfinished business can be put to rest.

Celebrate life

We now come to a third suggestion in helping patients who are dying. Celebrate life! How do you celebrate life? There is a place in pastoral visits to talk about joy those wonderful topics that light up the room.

How do you discover these topics? "I try to be very observant when I go into a patient's room," says one physician. "I look for pictures of family, a periodical on the dresser, a picture on the wall. Once I went to a patient's room to deliver unsettling news. I observed a copy of In-Fisherman by the side of his bed. Within moments we were talking about his favorite fishing lake and memories of catching a large pike. A bond quickly developed between the two of us that has sustained us through tough times."

When you focus on topics that bring a smile to a patient's face, you celebrate life. But you also celebrate by affirming that his or her life has meaning. Shortly before writing these words, I visited with a former colleague at the University of Minnesota. He had been retired for ten years and had recently been diagnosed with a serious illness. Before leaving I mentioned his many accomplishments. To my surprise, his eyes welled with tears. "When you are at this stage in life, you look back on your career and you see a lot of missed opportunities. I probably could have done a lot more with my life than what I accomplished."

When serious illness strikes, patients often do "negative thinking." The focus is not on the joys in one's journey. Nor is it on one's accomplishments. The focus is on the detours, potholes, and dead-ends. When that happens it is important to guide the conversation gently in a different direction. When I reminded my friend of the new pro grams he had started and the lives of students he had touched, a smile came to his face. He started thinking not about lost opportunities but about his success. And when he reflected on his accomplishments, serenity returned.

It is important for people to actually verbalize that which brings joy. Consider a 77-year-old, self-reliant farmer. Never sick, he was terrified by the technology to which he was connected in these final days of his life. He wasn't a man of many words. He didn't want to discuss his medical condition or talk about his faith, although I sensed that it was strong. What he did want to discuss, however, was his farm.

"What are you most proud of?" I asked. Without hesitation he said: "My land!" I must have looked puzzled, for he said, "I can tell by your expression that you aren't a farmer because every farmer knows that the land is every thing. Now, my farm didn't have good land. I was told that it was the worst in the county, and forty years ago my banker told me that I couldn't make anything of it. But I took classes on how to farm. I learned how to fertilize and how to rotate crops. I learned which crops grew best on the land and which to avoid. Five years ago, I had the best corn yield in the county." He paused and flashed a grin: "That's not too bad for a farmer with a sixth-grade education, is it?"

Not bad indeed! As he talked, he could barely contain his enthusiasm. The pride was unmistakable. And the joy of life could be seen clearly.

Everyone needs to feel good about their lives, and they need to know that they are leaving a legacy. Louis Pasteur, the pioneer of immunology, lived in an era when thousands of people died of rabies. For years Pasteur had worked to develop a vaccine. Just before he began experimenting on himself, a nine-year-old boy, Joseph Meister, was bitten by a rabid dog. The boy's mother desperately wanted Pasteur to experiment on her son. For ten days Pasteur injected Joseph with the serum he had developed, and miraculously the boy lived. Decades later, of all the things Pasteur could have etched on his headstone, he requested three words: Joseph Meister Lived.

I cannot overemphasize this point: All of us want to know that our lives mattered. We might not be a Pasteur, but we are parents, managers, salespeople, and teachers. We are electricians, attorneys, and clergy. And each of us wants to know in our heart of hearts that our lives made this world a better place in which to live.

Focus on faith

And now to the last suggestion: Focus on any unresolved issues relating to faith. Some individuals don't want to talk about faith, and their wishes should be respected. But most people want their pastor to focus on their spiritual health. How may one do this?

The starting point is to love people for who they are. Love has an incredible power to heal our wounds. When you love someone, they sense your acceptance, and it frees them to discuss their hopes and regrets, dreams and failures. It also enables them to talk about their faith and the questions they have about their future.

Most people have questions about faith, particularly in the weeks and months prior to death. In most in stances it is their pastor who can best provide the needed guidance. True, the work of physicians, nurses, and other members of the healing team can bring resolution to many of life's questions, and family members usually provide support and comfort. But in my experience, most want to converse with their minister about their spiritual journey provided there is a caring, compassion ate relationship.

Why do individuals wait until their deathbed to address important questions? "I never had the time to become involved in church," said one man. Said another: "Frankly, I never stopped to ask questions about God because I felt there were no answers." "For me," said an 18-year-old boy dying from bone cancer, "it was never cool to be part of a church crowd." Whatever the reason, these people had not made a serious inquiry into the meaning of faith. With death at the door, however, there is a strong need to inquire about the riddles of life.

What are the dying asking for when they inquire about faith? It varies from person to person, but, as we discussed earlier, most want affirmation that their life has mattered. And most want assurance that their Creator will see them through their darkest hour.

For example, a 44-year-old mother of three was diagnosed with stage III skin cancer. The cancer spread quickly, and she was brought to the hospice to die. She worried about her children, and wept when thinking about her husband, a gentle man who loved her deeply. Yet she seemed serene.

"Do you know what gives me the greatest joy?" she asked. "It's not my friends, although they are wonderful. It's not my family, although I wouldn't trade them for anything in the world." Her eyes welled with tears of gratitude: "It's that I know that I am loved by God and that nothing will ever, ever separate me from that love."

That is what faith is all about. Although not everyone reaches that level of acceptance, many do especially if guided by a compassionate pastor. What can you say to the person who is dying that might make a difference? Consider these marvelous biblical promises: "I have known you from the beginning of time. You belong to me and I belong to you. You are the one I love and on you my favor rests. I have molded you from your mother's womb. I have carried you in the palms of my hands and protected you in the shadow of my embrace. I look at you with infinite tenderness and I care for you with more tenderness than that of a mother for her child. I have counted every hair on your head and I will guide your every step. Wherever you go, I will be with you and wherever you rest I will watch over you. I will give you food that will nurture your body and a drink that will quench your thirst. I will not hide from you. You know me as your own and I know you as mine. You will always belong to me. Wherever you are, I will be there too. Nothing will separate us."

1 Robert Veninga, "The Search for the
Sacred: How to Find New Meanings in Your
Career," The Journal of Nursing Administration,
January 1996, 4.

2 Robert Veninga, A Gift of Hope: How
We Survive Our Tragedies
(Boston: Little,
Brown and Company, 1985), 264, 265.

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Robert L. Veninga, Ph.D., author of four books on grief and stress management, is a professor in the School of Public Health at the University of Minnesota.

November 1999

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