Ministering to families of the terminally ill ideally begins before the death occurs. Grief following loss has fewer complications if families have received adequate care prior to the death. The pastor can help them through anticipatory grief and build a trust level that makes the family receptive to bereavement support following the death. This also gives the pastor time to identify those who may be at high risk afterward.
Neglecting the family during illness may close the door on the pastor's chances to help the family. Such neglect can create resentment that hinders healthy grief.
Fortunate is the family that says, "Our pas tor spent a lot of time with Dad. His visits brightened the last few months of his life." Unfortunate is the family that must say, "Our pastor promised to visit Dad, but he didn't show up until Dad had slipped into a coma." Ministry to the ill person is also ministry to the family. They feel a load lifted when their loved one is receiving spiritual care. The family unit is the focus of care whether the visitor is a medical person or clergy.
A family that cares for an ill person is often weary and sleep deprived, left with little energy for chores around the house and errands in town. Pastors can organize and train church members to provide practical assistance.
Senior citizens often enjoy spending time with ill persons while the family catches a nap or runs errands. Pastors provide real ministry when they get involved in mowing lawns, shopping, and driving family members to appointments.
I can still see the smiles on one family's faces when I brought a big bag of apples and a sack of cookies. I always felt that this is the kind of ministry Jesus did.
My Amish neighbors demonstrate practical ministry to families facing the crises of illness. The bishop and members of the church community mow the lawn, clean the house, clean stables, fill the silo, and put up hay. They consider this their spiritual ministry. The bishop teaches by example.
Planning final arrangements
When the pastor practices trust and openness, patient and family may initiate conversations about funeral services. Days before writing this article a church member discussed with me her desire to end her dialysis. She tearfully told me what she wanted me to do at her funeral. This is a matter of relief for the family. It prevents last-minute stress for them.
They need to deny
I was involved in hospice development early in the history of hospice in America. Hospice staff people took the stages of grief given by Dr. Elizabeth Kubler-Ross as prescriptive rather than descriptive. They became overly concerned about leading patients and family from denial to acceptance, sometimes to the detriment of both.
Working with families has shown me that denial is visited periodically throughout the illness of a loved one. When illness is pro longed they may say, "He'll lick this cancer. Just look at all the hurdles he has jumped so far. He's a fighter." Denial can be a legitimate way of taking a little vacation from steady sorrow. It can put reality at a distance until a family has or perceives that they have support.
Families do not hold on to denial permanently. The wise pastor listens to them patiently and says to himself or herself, "This too shall pass." Such patience yields opportunities to help walk the patients through reality.
There are many reasons for denial: a desire to protect the sick from becoming hopeless, a need to protect self from pain, a fear that admission of imminent death will hasten it, wanting to keep a happy face for the patient, and so on. Each reason serves a purpose and is time-limited.
Cooperate with other caregivers
When I was a hospice chaplain, I invited patients' pastors to attend staff review when their parishioners' case was being discussed. They received valuable information that helped them in their ministry to both patient and family. Our staff received insight into the family system. It was definitely a win-win situation. Hospices are delighted to have pas tors volunteer their participation in patient-family care.
Recently an elder in my church lay dying in the intensive care unit of a hospital. The medical staff met with the family several times, but they knew that the family was not comprehending the seriousness of the elder's condition. The head nurse asked me to join a family meeting.
I was able to put some things into laypersons' terms and assure the family that the medical team was not being unreasonable. The family became more realistic in their expectations and the medical team's stress level dropped. The experience proved to me that medical professionals welcome clergy assistance when clergy persons stay within their reasonable area of expertise.
Don't forget the children
Children are sometimes neglected when adult family members require attention. It is easy to think the children are adjusting well because they only "visit" the loss for short periods of time and those visitations may be far apart.
One seven-year-old boy visited me after his father died. He would talk about his father for about five minutes, then he was off chattering about science fiction. But I stayed close to him for months anyway.
When he was a teenager, I moved to another state. As the moving van was being loaded, he stopped to thank me for helping him get through his tough time. I was impressed with how a little attention can make a big difference.
Children usually adjust to loss in a way different from the way adults do, and their grief can last longer. This causes parents and others to be alarmed. If there is any question about a child's reaction to loss, a parent should not hesitate to consult a professional in children's mental health.
A pastor should become acquaint ed with grief in children. An excellent resource is the longitudinal study done in Boston by J. William Worden (Grief and Children, The Guilford Press, New York, 1996).
Little things count
Home visitation may not be as frequent as a pastor would like, but a short phone call to check on the family is always helpful. A fresh flower arrangement sent to the patient's bedside is a real pick-me-up. Cards and phone calls from church members bring encouragement. A video or tape recording of the church service is an excellent way of involving the patient and family in church life.
When my family and I went through a crisis of loss, a neighbor called and told us not to fix supper. They brought the food, table settings, tablecloth, and candles. They told us to turn off the kitchen light when we finished eating, as a signal for them to come over and clean up the kitchen. What a blessing!
There are other ways to help. Make a phone call just before your family goes grocery shopping. Ask if there is anything you can pick up for them. A loaf of homemade bread or an apple pie dropped off on your way to an appointment can cheer a heart that is weary with sorrow. If Jesus were doing His ministry now, I can see Him doing things like this.
Keep the funeral in mind
As the pastor mingles with the family and the ill person, he or she should keep little tidbits of the relationship in mind. Engaging the sick one in a life review provides excellent material for a life sketch at the funeral.
I've been to funerals where the life sketch sounded like it was written by the department of vital statistics. Involvement with patient and family before the death should be a mine of precious memories that can be included in a tribute.
A young pastor told me that he spends a half day writing any life sketch to be given at the funeral. He feels that this is just as important as the homily. Families tell him how much the sketch meant to them.
The values and faith of the family and the ill person should be the basis of the funeral service. This can hap pen if the pastor is really present with the family.
The funeral is the time to bring comfort and hope to the family and friends. It is not the time to evangelize and call for people to give their hearts to the Lord. It is not the time to review all the doctrines of a particular denomination. I helped a young pastor conduct a funeral. I read the Scriptures and presented the life sketch written by a family member. The pastor presented the "homily" in a voice loud enough to address thousands. The content was what I would expect from an evangelist attempting to convert people to his denomination.
I watched the audience squirm and the family drop their heads in embarrassment. I discovered later that the pastor had not experienced much training for ministry. His only experience was an apprenticeship with a traveling evangelist.
Allow questions and doubts
It is not unusual for family members of the dying to be angry with God. They see a loving and kind relative dying. They consider it unfair. They have prayed, but the prognosis has only worsened. Sometimes a whole church has fasted and prayed, but death has simply drawn closer.
One family invited their entire church to the hospital to pray for their daughter who was on life sup port. They filled the family room and spilled into the hallways. The pastor insisted on burning candles in the intensive care unit, a request that was forbidden in an environment where oxygen was in use.
A day later the 18-year-old girl died. The family's faith was shaken and they left the hospital exhausted, emotionally depleted and spiritually disillusioned. This is not always the case, but when it happens pastors have their work cut out.
What are they to do?
Their first obligation to the family is to listen, listen, listen. Anger at God is a cry of desperation that does not beg for the pastor's answers. It calls for quiet restraint and acknowledgment of their pain and overwhelming sorrow.
For personal reasons, I know whereof I speak. I lay in the hospital with the diagnosis of lymphoma (which turned out to be negative) and I was filled with a strange mixture of anger and bewilderment. A hospital chaplain came to my room with words, words, words, but I felt misunderstood and miserable.
I asked the head nurse to call for a nun to visit me. She sat by the head of my bed, gently grasped my arm, and invited me to share anything on my heart. She didn't rebuke me for my feelings and she didn't preach. She quietly acknowledged my anger and my pain. That's what I needed.
I'll always remember the young woman who was diagnosed as having leukemia. She emphatically told me she did not have leukemia, yet she expressed anger and confusion at the same time. I told her that I would rejoice with her if the diagnosis proved wrong, but if not, I would be present to try and feel a little bit of her pain.
Two days later when I entered her room she said, "Chaplain, sit down on my bed. I want to hug your neck!" She then told me she had leukemia and was waiting for me to come so she could unload.
Unload she did. There were tears and there was laughter. There was anger and there was a peaceful surrender to God's will. She had many questions and doubts, but she let me know that she didn't expect answers. She was grateful for my presence and my willingness to put up with her ranting and raving.
Her situation and her concept of God didn't mesh. She needed time to analyze her picture of God and to reshape it to harmonize with her run away life. Her assumptive world was shattered. A different world had to be shaped before she could find peace. I listened as she did so.
After many tears she said, "Chaplain, Jesus went through more for me than I am going through for Him. I'm going to hold my head up high and take whatever comes because I think He's got something better planned for me than this old world."
She confirmed what I had learned from dozens of families facing the death of a loved one. Be quietly present in the midst of anger, doubt, fear, and confusion. Let the Spirit of God do the speaking. Let Him impress answers on the hearts of family members. Be His quiet under-shepherd.
The one argument I have had with a few hospices has been regarding their policy to terminate family care one year after the death of a loved one. I have met families who have expressed the feeling that they were being dumped.
A pastor should not set limits on family care after a death. More than a year after a loss there are apt to be sub sequent, temporary upsurges of grief. This is true because all the bits of memory connected to a person do not come up for review and grief within a year. When a familiar song, an event, a special place triggers memories yet unvisited, the pain of grief returns.
When a family experiences this, they need to know that their pastor is ready to minister to them. If a family seldom or never sees the pastor after the funeral, the pastor should not be surprised if they do not frequent church services. Neither should the pastor be shocked when that family moves to another church.
With today's strong emphasis on church growth, hurting families can be overlooked. Pastors need to consider that church growth is about more than numbers. It is about the spiritual and emotional growth of people already in the church.