Dying With Dignity 1
In April 2003, I was a student chaplain for a few weeks at two hospitals in Glasgow. I was focused on the cancer wards of the Western and Gartnavel hospitals, where I was learning under the watchful eye of Reverend Stuart MacDonald, (then) the minister of Knightswood Baptist Church. I was on placement from the Scottish Baptist College and I was there to grow in understanding, to gain new experience, and to grow my pastoral care skills in a very demanding and difficult environment. I will always be grateful to Stuart MacDonald for allowing me to be alongside him for that placement time, and for trusting me to get on with being a student chaplain without the need for Stuart to be always on my shoulder.
When the placement had ended, I would be required to evaluate my pastoral care skills as shown (or otherwise!) from the placement, and try to integrate biblical narrative, theological principles and the practice of pastoral care. In the environment of the cancer wards of two busy hospitals, I was also to understand more about the need for human beings to be able to live and die with dignity.
As a student chaplain on that placement, I usually went around one or more of the oncology wards in the mornings and there spent time with the cancer patients, talking with them as much or as little as they wanted to. As I approached one bed, I could see that the man, probably in his forties, had major scarring on his forehead. I introduced myself and he told me his name was John. (Not his real name)
John told me that he had had surgery for a brain tumour, and that he was now awaiting the results of further tests so that the doctors could decide on their future course of action. We talked about his home, his family, and explored the context of where he had come from to arrive at this point. I shared about my own context and why I was in the hospital, as well as discussing with John my personal call to pastoral ministry. John seemed reasonably hopeful that the doctors would do something for him, and that he could get back to his life in the near future.
I was back on that same ward a week later, and, for the first time, met and talked with the ward Sister. We discussed issues related to people whose life was suddenly disrupted by the discovery of cancer. She spoke of how the control of your life can suddenly be wrenched from you by finding out that you have an inoperable brain tumour, and that you would therefore be dead within a matter of weeks.
I knew who she was talking about and said so to Sister and related the conversation that I had had with John the week before. Sister then told me that John had effectively known that his situation was terminal as long ago as the week before I had actually met him, but that the final confirmation had been given to him in the last couple of days and that he would be going home to die. I went out and began my round of the ward.
I had not been on the ward very long when, in the course of walking between two sections of the ward, John and I almost bumped into each other. I looked at him and asked him how he was doing. Tears filled his eyes as he said quietly, “They’ve dealt me my cards.” I suggested we go to his bed and sit down together.
We sat down on his bed, but all he could do was tell me once again that they had dealt him his cards. I couldn’t say anything, and all I could do was to put my hand on his shoulder. A few seconds later he excused himself because he said that wanted to go for a cry.
LOOKING THROUGH THE GLASS
While I was a student hospital chaplain during that recent placement, I was very aware of the real tension between me being a student who was on the wards to learn from others, and the fact that patients often related to me as a professional who was competent to do the job, or else I wouldn’t be there at all.
I was, and I am, very aware that I do not have all the answers. Indeed, I am certain that I have very few answers, if I have any answers at all. The close inevitability of dying causes an unparalleled awakening of a sense of awe combined with an unparalleled sense of panic in the person concerned.
At a personal level, I had experience of how people handled dying – not just their own terminal process, but also the final days of other people. This was true not only in my immediate experience of family, but also in observing how professional people handled people dying in front of their eyes. In speaking about the many people who are professionally involved with the dying, Oden said that ‘only the fact of death is dealt with, not its meaning.’ How, then, do I bring meaning to a dying human being?
It is relatively easy for me to rehearse ahead of time what I might say when confronted with a person who is in a situation like that experienced by John. It is altogether a different thing when you are suddenly face to face with someone who will soon die, and you did not anticipate the meeting.
When I found myself in just such a situation, I felt a helplessness to do anything, but I also had an inner unwillingness to use words cheaply. I wanted rather to have what Lyall called the ‘grace in having nothing to say’. If I am truly honest, I also had an overwhelming desire not to be in that situation at all. Running away was not an option, however. I was there, and I had to be able to practise Lyall’s ‘support without interfering.’
Wilcock addressed how I felt in that situation. He said, ‘The addressing of our own helplessness is necessary to stop us running away, or taking refuge in false optimism, or withholding from the dying person permission to explore with us their fears and grief.’ But to give to a dying person the permission to explore with me their fears and grief only finds true meaning if I, too, am exploring and knowing myself in the same way.
That is true not just because of the particular situation that I may be in, but also because it is helpful for me to know what I am like in my inmost being, and to look at who and what I am in the light of the Holy Spirit who shows me what I am truly like in his eyes.
Would a dying person engage in that kind of self-exploration as I spend time with them? Surely it would be a little easier if the reassuring presence of the Holy Spirit can be sensed through my own openness and honesty? I must let the dying person know that I have not come to preach at them, that I am not there to convert them. No! The person needs to know that I am rather there to love them as Christ loves them. I must try to work out what that looks like for the person in front of me. I do not want to threaten them, and I want them to be comfortable with me.
In the light of even my own limited experience, I can understand why, in the face of terminal illness or death, evangelical hardness and legalism must give way to truly loving people as Jesus loves them. I can understand why loving people is far more important than winning converts; that being friends with people is much more important than preaching at them.
These words from the Church of Scotland’s ‘A Church Without Walls’ report are surely important here: ‘Here friendship is about commitment to each other (“No one has greater love than this, to lay down one’s life for one’s friends”) and openness with each other (“I have called you friends, because I have made known to you everything I have heard from my Father”).’
I can understand why so much of church does not touch people’s real lives, and I can see why it does not help them when they are asking the serious questions of life and death. These questions are not only on the lips of the dying, but on the lips of their relatives, too. It is easy to be trite, neat and theologically clever; but where is my love? If people cannot share their lives with me, how will they ever share their death with me?
As a student chaplain, I was meeting some people who were caught up in what Nuland called the system of ‘modern dying in the modern hospital’ where they slip towards their modern burial. Yet, as Nulande says, if ‘a young doctor learns no more important lesson than the admonition that he must never allow his patients to lose hope, even when they are obviously dying,’ how much more must those of us who call ourselves Christians bring a real hope to the diseased and dying? Can I be short on answers but full of love for such dying people? Could I be a person of hope for someone who medical science now terms as hopeless?
As I went out onto the hospital wards to do my rounds on each of those mornings, I would look through the windows of each section as I approached in order to get an overview of the patients who were in that area before I went in. This routine quickly became a habit. But so, too, did my inclination to think about patients, and I had to constantly remind myself that I was not in the hospital to see patients; I was there to meet with people who were in need of people who would accept them and love them as people.
Likewise, in a church context it is easy to have a system of pastoral care that treats people’s needs without drawing close to the people themselves. It is actually very easy to do. Someone presents a problem, you present a prayer, and God presents an answer. I wish! But it does not always work like that.
John taught me afresh that I, too, am a person who needs love, and that I will often find love as I give love; he taught me afresh to value every individual member of the human race as God surely does. We can, of course, know what we ought to do; but knowing how to do it is quite a different matter.
When I met John, I met someone whose greatest need was to know love from someone who could be more than a friend during his time of great need. Though he may not have verbalised it in this way, he needed someone to love him. Someone who would love him not because he was terminally ill, but because he was a person in his own right. He may not have said in this way, but he needed someone who would love him as Jesus loves him. He certainly would not have verbalised it that way. Nevertheless, that is what he really needed. To accept him and to care for him as Jesus did.
Gone is the time for scoring theological ‘Brownie’ points or notching another convert on the hit list. For me in that situation, it wasn’t even important that I try to analyse what John was feeling or going through; I just knew that he needed someone and that I was there. Like Nuland, ‘I would listen more to the patient and ask [him] less to listen to me.’ In this student chaplain, John found a non-threatening person with whom he could share his profound sense of personal shock; I found someone with whom I could share my profound sense of personal love. John may have felt that the giving in our times together flowed just from me to him, but I knew better than that.