Ministry to people facing life-threatening illness

How does a pastor relate to people who are facing death?

Larry Yeagley, now retired, has served as a pastor and chaplain. He lives in Gentry, Arkansas, United States.

Any pastor harboring an illusion of immortality will be hindered as he or she attempts to minister to a seriously ill parishioner. It is vital that we consider the inevitability of personal death. If not, the parishioner may receive few visits because contact with dying people may create anxiety in the pastor. Some pastors with low personal death awareness refuse to engage parishioners in conversations about their illness and prognosis. A pastor with low personal death awareness cannot adequately meet the needs of critically ill patients.

They are losing everything

Family members of the dying person face losing one person, but the one dying faces the loss of all family, friends, relationships, positions in the community, and possessions. Amazingly, the dying person usually adjusts to the many losses before the family adjusts to their loss.

The sustaining ministry of a pastor can assist the parishioner with anticipatory grief. This is the incremental awareness of diminishing health and the mini-losses it brings. Anticipatory grief is adjusting to the loss of things such as self-feeding, self-bathing, driving a car, contact with friends, church attendance, and going to work. The dying person can face death with greater ease when a pastor steadily and regularly is present to hear, listen to, and acknowledge the strong emotions that go with such losses.

They need to communicate

Family members frequently avoid talking about worsening prognoses and imminent death. The ill person usually wants and needs to communicate. A pastor who has comfort ably and privately discussed the issues of illness and death with a parishioner is often asked to facilitate family communication.

A Texas rancher fell silent when he visited his wife in the hospital. She wanted to discuss the metastasis of the cancer, but she didn't know how to bring it up. With her permission I invited her husband to sit at the head of her bed. I told him, "John, Rachel received bad news today and she wants to tell you about it. I'll stay by in case she needs help, but once you two get the conversation rolling, I'll step out and give you privacy." Both told me later that I had opened the door to a conversation they longed to have but didn't know how to begin.

They need your loyalty

I tell ill parishioners and their families that "I am going to be by your side through good times and bad. There is nothing you can say or do that will frighten me. You can talk, cry, scream, or grow silent, but I'm going to be your friend no matter what happens." I stand by that promise.

Expressions of doubt, guilt, anger, hopelessness, sorrow, and being forsaken by God are all part of facing personal death. The ill parishioner doesn't need a pastor to scold, admonish, or buoy her up. She needs a pastor who shows no alarm or displeasure, just acceptance. As a patient in a psychiatric hospital said many years ago, "What we need above all else is someone who accepts us as we are, for what we are, so that we can become more than we are." The same need is true of the critically ill parishioner.

I have listened to dozens of cancer patients say negative things about God, but I made no defense. My steady, friendly presence joined the steady, friendly presence of God. Patients have said such things as, "I can't believe you keep visiting me after the awful things I said about God."

They need to have a purpose

Illness often terminates involvement informal vocations that have provided a consistent sense of meaning and purpose for the person. Family, friends, and the church sometimes view such a parishioner as helpless. There is no reason why many ill people, such as a women's ministry leader, for example, cannot function in a hospital bed or in a semi-ambulatory condition at home. A member of a finance committee can serve in an advisory capacity. A sick church elder can meet with the rest of the elders in his home.

A pastor can keep parishioners abreast of church life and ask them for their advice about important issues. When I visit ill parishioners, I make it a practice to repeatedly say, "I really appreciate you spending time with me today. Thank you for the encouragement and advice. I always learn valuable lessons when I visit you."

I have often visited sick people to give them encouragement, but found myself on the receiving end. Their situation has equipped them to give me spiritual counsel and assurance. One of my nieces told her aunt, "I don't talk to God very much now. I don't have much time left, so I'm just going to enjoy His friendship." I wasn't present, but her spiritual maturity has been tutoring me ever since I heard about her comment.

They need pastors who try to understand

When I met Dame Cicely Saunders at the first national hospice convention in Washington, D.C. (she was then director of St. Christopher's Hospice in London), I asked her what a terminally ill person wants most of all. She had just asked that question of a patient. His reply was, "For some one to look as if he is trying to understand me."

A pastor doesn't know how a sick parishioner feels any more than he can breathe through that person's lungs or see through his or her eyes. To say, "I understand how you feel" doesn't make sense, nor is it comforting.

They sometimes protect family

Rick's wife fought cancer for years, but now she lay in a hospital bed during the last week of her life. During Rick's visits she expressed strength and acceptance of her situation. But the night before her death she asked her favorite nurse to hold her in her arms. Safe in the nurse's careful embrace, she wept and said she did not want to die. She put her deepest sorrow into words that she could not share with Rick.

Pastors can expect to hear emotional outpourings from ill parishioners, expressions that are kept from family out of love for them, and out of a desire to shield them from greater sorrow.

They review their life

Once people know they have a terminal illness, they spontaneously review their life. Making sense of the past clears the way to face the present. This process includes grief, laughter, love, joy, gratitude, a sense of accomplishment, and sometimes awareness of failure.

A pastor needs to give a patient encouragement so that the parishioner can complete his story. She can also assist the person in summarizing his or her positive contributions and achievements.

I spent over an hour listening to an elderly woman telling her life story. When she finished, she embraced me and said, "What you and I did together here was a prayer."

They are lonely

Many terminally ill patients feel alone, out of touch, and untouchable. Loneliness includes frequent weeping and nostalgia for the life they have had, that will never be again. It embraces knowing that all that life provided will be lost. Loneliness is exacerbated by the awareness that fewer people choose to spend time with them.

Touching is like a soothing mas sage to the person whose sense of personhood has been shattered. Human touch erases the distance between two people.

Cheryl, a hospice nurse, taught me to be unafraid of holding a hand or giving a hug. Her patients told me that she made them feel warm and a part of her family. They looked for ward to her visits. Terminally ill patients need a pastor who isn't afraid to touch away their loneliness.

Years ago a friend of mine was taken to a tuberculosis (TB) sanatorium. As soon as I heard about it, I visited her. I went to the head of her bed, grasped her outstretched hands, and greeted her warmly. Instead of smiling, she burst into tears tears of joy, tinged with some hurt. Joy because she no longer felt untouchable. Hurt because her pastor visited her while standing ten feet from the foot of her bed. He didn't touch her once. After a quick Bible verse and a prayer, he headed for a sink just out-side the door to her room. She watched as he scrubbed his hands and arms. She felt like a leper.

My friend's life was taken by TB. I am so grateful that I had the privilege of easing her loneliness and feelings of abandonment.

They reach out to God

The capacity to relate with God continues until consciousness ceases. For this reason alone a pastor's ministry should intensify as death approaches. The ill person needs the validation and support of attendance at religious services as long as possible. Bringing audiotapes and videotapes of church services into the home is a good idea. Any type of involvement in one's faith community protects against or helps to relieve the depression often experienced by the terminally ill parishioner. Knowing that God is on their side is a real boost to morale.

An ill person prospers more when family and friends are near, but the pastor can ascertain whether that per son has adequate time for solitude and meditation. There needs to be a balance between being alone and having togetherness.

Many patients nearing death have grasped my hands tightly and asked for prayer. I shall never forget what Mr. White told me after my prayer with him ended. "Chaplain, I have a peace about me that I never had before. God and I are on good terms." I felt that I had just reached the pinnacle of my ministry. His was not the only peace. I, too, had peace, because I reached out to God along with Mr. White.

They need professional care

In spite of publicity, a surprising number of families are not aware of the services provided by hospices. A pastor would do well to become involved with the local hospice so that he can make referrals.

Hospices make it possible for an ill person to die at home with dignity and with less stress on the family. They advocate placing a bed in a sunny room near family. This prevents the feeling of abandonment. Hospice staff provides nursing care, respite care, some medications and supplies, housekeeping, chaplaincy services, and social services to care for the inevitable paperwork.

When my mother-in-law was ill, hospice personnel went the extra mile to meet the needs of patient and family. The last day of her life the hospice nurse provided the usual morning care. At the end of her day, she had an urge to swing by the house to see how things were going. She arrived just as my mother-in-law was dying. Quietly she comforted us and made all the necessary phone calls. Our family will always feel gratitude toward that hospice staff.

Some hospices are now building hospice houses. I attended a ground breaking for one in my community. Sunny rooms, wide doors to accommodate the width of a bed, quiet rooms for family conversations, a chapel, and even provisions for the family pet to visit these and other features are part of hospice houses. When a terminally ill person doesn't have family or a primary care provider, he or she can make the hospice house a home.

There are times when a patient or family cannot communicate with physicians for some reason. The pas tor, with permission from the family, can convey their wishes to the physician. Usually the physician is unaware of their need for further explanations or clarification. I have always found physicians grateful for my intervention.

Yes, there is pain involved in ministering to the dying, but the sacred opportunity of loyal pastoral support for one of God's children is worth all the pain. To see a person close life with dignity and God's peace shining forth is, to me, the greatest joy of ministry.

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Larry Yeagley, now retired, has served as a pastor and chaplain. He lives in Gentry, Arkansas, United States.

July 2003

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