I always find it interesting to ask other chaplains about what led them into this work.  It is, after all, a distinctive calling, one many people think they are not well suited for.  Chaplains often have an “origin story” or two that they can identify, in retrospect, as pivotal to their journey.  Here is one such story.

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Pat was the daughter of Irish immigrants who grew up in the Jackson Heights neighborhood of Queens, in New York City.  During World War II she met Jack, a young Navy officer from the Midwest, at a USO dance.  She succumbed to his charms despite their religious differences—she a Roman Catholic, he aligned with the spirituality of Ralph Waldo Emerson—but they agreed that their children would be raised in the Catholic Church.  And so the children were, all six of them, but they came of age in the 1960s and their religious upbringing was far from smooth.

When the younger son, Greg, neared middle school, he was pulled from the parochial system that was generating conflict with the older children and placed in a secular school.  Soon he lobbied his mother to be released from obligations to attend Mass and catechism classes, repeating the criticisms of the Church he’d heard from his siblings.  She insisted on a series of debates regarding religion, challenging the platitudes Greg spouted and pushing him to think substantively about matters of faith.  When she was finally convinced, she released him with this admonition: “I’ve never confused the Catholic Church with Jesus Christ, and you shouldn’t either.  Don’t throw the baby out with the bath water.”

After Greg’s sophomore year in college, Pat travelled to New York for the ordination of a nephew as a Jesuit priest.  She struggled with shortness of breath and weakness during the trip, and upon her return was diagnosed with advanced lung cancer and heart disease.  After considering the options available in 1975, she declined treatment, accepting the prognosis that she had less than six months to live and choosing to make the most of it at home among family and friends.  She and Greg, who was living on the other side of the country, resumed their discussions about religion by phone, and she impressed him deeply with her faith, her courage facing death, and her gratitude for what life had given her.

Greg traveled home to see her as soon as he could, but she declined suddenly during his trip and was on her deathbed when he arrived.  After a time at her bedside, holding her hand and saying his goodbyes, he took his place with his father and other siblings around her bed.  He remembered thinking, “It’s amazing to see such confidence in her final moments.  I wish I could believe what she believes—that she will soon be face-to-face with Jesus—because it’s so powerful for her right now, but I just can’t imagine believing any of that.”  Pat died a few hours later.

It took Greg years to process this experience—especially the full meaning of losing his mother—but on that day death was transformed from an abstract notion to a concrete reality.  Thanks to Pat’s example, he came to understand that mortality is something one can not only accept but embrace, that acknowledging the finite time one has to live can open the door to candid, meaningful conversations, and that the best way to go through the experience of death is in the company of loved ones.  This gave Greg the foundation for accompanying others through their own experiences of the death of loved ones, first with family and friends, and, later, with patients as a chaplain.

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In writing Elder Chaplain stories, I change many patient identifiers—name, age, diagnosis, even gender or race—to protect patient confidentiality, while still seeking to capture the essence of our encounter.  I have no need to do so in this post.  Pat was my mother, and this is my story.

I decided Pat’s story needed telling because it is both extraordinary and ordinary.  It is extraordinary in that stories like this were far too rare in in America in 1975.  In the years following World War II, death—and childbirth—became increasingly medicalized, taking place primarily in institutions, and attended to more by medical professionals than family members.  The idea of hospice was not introduced in the US until 1971, and it was a foreign concept to those treating Pat in 1975.  Still, she chose that approach for her own death—without today’s more effective pain management—and it was a gift to all of us in her family to experience her death at home, by her bedside.

As I reflect on why Pat embraced this approach, one factor surely was On Death and Dying, the 1969 book by Elisabeth Kübler-Ross, MD, that introduced the now-familiar stages of grief:  denial, anger, bargaining, depression and acceptance.  My sister was in nursing school in the early 1970s, when the book was required reading; my mom decided to read it with her, and I joined in as well.  When she received her diagnosis three years later, I think this book gave her the framework she needed to argue back to her doctors, who were still of the mindset to treat at all costs.  More importantly, for me, it gave us shared language to talk about her experiences approaching death.  I still have her yellowed copy of the book—her signature inside the cover is the only thing written in her hand that remains with me today.

Now, almost 50 years after Pat’s death, dying at home with supportive hospice care is no longer extraordinary.  The use of advance directives outlining one’s wishes for end-of-life care is now more widespread, and hospitals regularly conduct multi-disciplinary “goals of care” conferences with patients and families (and chaplains, if desired) to discuss options for treating advanced illness—including no further curative treatment at all.  Patients increasingly understand that such life-and-death decisions are theirs to make, not their doctors.  It remains a struggle for some elderly folks—who formed their attitudes about aging and death in the 1950s and ‘60s and often equate hospice with “giving up on life”—but we have come a long way toward Pat’s story becoming ordinary.

Still, if “normalizing” death—giving people as much agency as possible to dictate the setting and circumstances of their own deaths—is a goal we seek for ourselves, then we also need to normalize the work of accompanying others in the process of aging and dying.  I often hear statements such as, “I could never do what you do—I would find it too depressing.”  While I grant that a steady diet of this work is not for everyone, the work of accompaniment shouldn’t be delegated to chaplains any more than decisions surrounding end of life should be delegated to doctors.  My hope for Elder Chaplain is that it helps all of us become more comfortable, skilled, and experienced with this work.

Fortunately, nowadays I see many more people like Pat making thoughtful, courageous, and spirit-filled choices to face end-of-life on their terms—and, in doing so, providing gifts to their family members like Pat gave us.  It is my hope that they are not only planting the seeds of future chaplains, but also building “chaplaincy attitude” in all with whom they engage, so that as a society we can reclaim the skills we once had before the medicalization of death.