I was finishing ICU rounds, where the nursing supervisor gives other teams a succinct rundown on all patients on the unit, when a nurse entered and took me aside.  “The patient in room 7 is about to get some bad news.  They appear to be people of faith, so we thought it might be helpful for you to be there.  Can you come right away?”

I arrive to find Dr. Jonas, a palliative care doctor with whom I often work, standing outside the room, speaking with a nurse.  We confer briefly.  Joe, in his 50s, had been diagnosed with lung cancer more than a decade ago, but with medication it has been kept at bay.  He collapsed over the weekend, and the results of tests conducted over the past 12 hours are grim.  The nurse informs us that his wife, Louise, and their two daughters—one a young adult, the other only 14 years old—are gathered bedside. 

We nod, take deep breaths, and enter.  Joe is a large man in obvious discomfort, with very labored breathing.  After introductions, Dr. Jonas moves closer to Joe, then addresses Joe and his family.

“I’m here because we need to talk about some difficult news and make some hard decisions.  Before saying more, I want to make clear that no one needs to be part of this conversation who doesn’t wish to be.  It’s up to each one of you.”

The family members exchange nervous glances among themselves.  Louise and her adult daughter both seem clear in their desire to remain.  All eyes turn to the younger daughter holding Joe’s hand at the side of his bed; she clasps him more tightly and says, “I’m not going anywhere.”  Joe smiles weakly, then returns his gaze to Dr. Jonas.

“OK, then … thank you.  Joe, as you know, the cancer that was diagnosed 13 years ago never went away, though its growth has been managed.  The scans we’ve done since you arrived yesterday show it has now grown and spread.  What’s more, the pericardial sac surrounding your heart has become calcified, impairing your heart’s ability to pump.  The weakness in your heart is causing fluid to build up around your lungs, which is why your breathing is so labored.  Your cancer and heart conditions have advanced to a stage where treatment options are limited, and your decline is likely to continue.”

Joe takes this in without overt emotion, then asks, “How long do I have?”

Dr. Jonas pauses, then replies.  “A few days … at most.  Perhaps only hours.  We can continue to treat your symptoms with the goal of prolonging your life to the extent feasible, or we can discontinue treatment and make our primary goal maximizing your comfort during the time you have remaining.”

Joe’s eyes brim with tears as other family members begin silently weeping.  Dr. Jonas allows time for the news to settle, then continues.  “Please take the time you need to decide your goals of care.  I’m happy to address any other questions you might have—just let me know what you need.”

“I need prayer.”

“And that’s why my colleague Greg is here,” Dr. Jonas responds.  Joe nods, and I switch places with Dr. Jonas.  After inquiring about their faith and learning they are evangelical Christians, we join hands and I offer what words I can muster to bring God’s presence, comfort, courage, wisdom, and love into the room.

“Dear God—We know you are with us always, but we ask you to make your presence deeply felt in this room, that we might feel your accompaniment in this moment.  You know all of what Joe and his family are facing today, and the deep pain in each of their hearts as they confront the end of Joe’s life.  Please help them remember that your love transcends death, that you will welcome Joe into eternal peace with open arms, and that you will remain a comforting presence to his family when he is gone.  Please fill them with your courage and wisdom as they make decisions about Joe’s plan of care.  We ask all these things in the name of your son Jesus Christ.”

Joe died in comfort later that afternoon, surrounded by his family and their longtime pastor.

◊

One of the things I love most about the hospital where I work is its commitment to compassionate care and to treating the whole patient—physical, emotional, and spiritual.  As this story illustrates, our hospital chaplains are considered an integral part of patient care, not an afterthought.  Our staff grasp that the care that we offer, whether explicitly religious or simply a calming presence, is something distinctly different from any other care discipline in the hospital, something deeply valued by many patients and their families.  It is a privilege to be included in this way.

Of course, part of what comes with this privilege is the need to be present and helpful in difficult situations like the one in this story.  Friends sometimes comment that they don’t understand how I do this work, and some days I don’t understand, either.  As I switched places with Dr. Jonas and looked deeply into the eyes of a man who had just received his death sentence, I wondered what I could possibly say that would meet the hope and expectations Joe and his family had for my prayer.

Fortunately, Dr. Jonas and other caregivers have modeled for me how one can balance directness and compassion when discussing difficult matters.  There is a stereotype of heartless doctors conveying news of terminal illness as if it were an update on the weather, then walking out as if their job were done.  Sadly, I’ve heard plenty of tales that support this stereotype.  But that’s not what happened here or in other situations in which I have participated.

Dr. Jonas set the tone at the outset that this conversation would be difficult, but then let each family member opt in or out of participation.  This consideration of each person’s needs offered them a sense of agency, and their informed consent to remain present braced their hearts to hear more.  Dr. Jonas used non-technical language to the extent feasible to explain Joe’s condition and options, and extended an open-ended offer of support.  Joe and family, while unavoidably in shock, nonetheless felt respected, cared for, and empowered.  That preparation laid a strong foundation for effective spiritual care.

In asking for prayer or any kind of compassionate presence in a time of loss, people are usually seeking a reason for hope.  Sometimes that hope is grounded in a religious vision of afterlife, sometimes it’s in the prospect of being released from prolonged suffering, sometimes it’s in the knowledge that they will not be left to die alone.  In my experience, it is almost always about a desire to feel connected to something greater than themselves, whether a religious deity or a universal creator or simply other humans—to sense that they are not alone, that they are beloved.

The first step for someone offering spiritual care is to directly acknowledge the difficulty of the situation, the reality of the loss being felt.  Failing to do so disrespects the patient and, by distancing the caregiver from the patient’s pain, undermines the process of spiritual healing.  It is then crucial to inquire about the patient’s faith or spiritual beliefs, so that the care being offered is aligned with the patient’s beliefs, whatever they may be.  With that foundation, spiritual care is then often a matter of making that source of hope deeply felt, present, tangible, and comforting—in spite of the loss.  Even if the patient cannot articulate any source of hope, the presence and accompaniment of another person in the reality of the patient’s loss and grief can bring solace to an otherwise bleak situation.

And that is what I sought to do for Joe and his family that day.  I might have fallen short of the prayer they would have received from their pastor, but I left with the sense that they felt the comforting presence of the God of their faith there in the room with them, and that this helped prepare them as a family to face the difficult decisions in front of them.