Born Under a Bad Sign

“Hi, my name is Greg, I’m one of the chaplains here, and I have come by to offer conversation …”

I have just entered the dimly lit room of Hector, a man in his 50s with a nasty abscess.  As I speak these words he comes into focus:  a shaved head, heavily tattooed arms, staring out the window.  He is visibly agitated, rubbing his eyes with his forearm, sniffing.  He neither accepts nor declines my offer.

“… or company, or whatever you might want.”

After more silent agitation, he begins without looking toward me.  “Everything is so f***ed up right now, I have no idea what to do.  My girlfriend, if that’s what she is, dragged me up here from Arizona—said things would be better here.  But I don’t know anybody here, and now I’m stuck in here and she doesn’t care.  She was supposed to come by today but she’s not, she’s going off to get high with friends.”

“I’m so sorry, Hector.  That’s really hard.”  I sink slowly into the chair beside his bed.

“I want to get out of here and go back to Arizona, but she’s got my wallet and I don’t have any money.  If I go back I’m facing 10 years, but I’m thinking maybe prison’s better than being here, at least there I know what’s what.”

I nod silently, offer a sympathetic grunt.  I am truly at a loss for words.

“I’m trying to get clean after nearly OD’ing and she said she’d help but she’s started using again.  Every time I try to say anything to her about that she just pins it all back on me.  Everything is my fault.”

“You’re trying to get clean, and that’s hard to do when the person you’re with is using.”

Hector looks toward me for the first time.  “Exactly.”  He looks away again.  “I’m clean all right—I’ve been in here for two weeks—but now all these feelings are coming up that I’ve never let myself feel before and I can’t stand it, it hurts so bad.  All I want to do is use again to make the pain go away.”

“I’m sorry, Hector.  That sounds awful.”

“We were trying to get help at a shelter here. They told me all I need to do is put my faith in Jesus, to trust God and God will take my pain away.  How the hell is that supposed to work?  I’ve tried reading the Bible like they told me but I can’t find anything in there that helps me.”

“Sometimes people use the Bible in ways that they think are helpful but actually aren’t helpful.”

Hector turns toward me again.  “Not helpful at all.  When I OD’ed I called my grandmother and all she had to say was that the Bible says suicide is a sin.  That didn’t help anything.  It’s true, I suppose, that using heroin is like trying to commit suicide.  But I was born addicted …”

“From your birth mother?”

Hector nods, then turns away.  “Got put up for adoption.  My adoptive parents were pretty good to me but we never had any money.  So I started stealing stuff to make money.  My mom died when I was 14 and my dad when I was 15 so I joined a gang to have someplace where I felt like I belonged.  I went into prison when I was 19 and that’s where I’ve spent most of my life.”

“That’s a hard life, Hector.”

He looks toward me and nods again.  Just then a doctor enters, and we both know our time is up.

“I just appreciate you listening, letting me say all this instead of keeping it bottled up like I usually do.  I hate feeling like this, I hate that I’m crying like this.  But I can’t tell you how much it means for you to come and listen to me.”

I only made it 10 steps from Hector’s door before I needed to take a seat and try to absorb this conversation.  I have listened many times to people raised (or still growing up) in difficult circumstances, but this one struck especially deeply.  The excerpts above only begin to capture Hector’s rage, his sense of betrayal by everyone in his life, the way his pain pierced him to his very core—and his beautiful spirit.  Like so many patients I see, I left his room wanting more—not so much to learn more personal history, but to experience his humanity more fully.  Sadly, this was our only visit.

Approaching Hector’s bed, though, as I settled in to his physical presence and recognized the evident gap in our life circumstances, my main thought was, “What could I possibly say to this person that might establish a connection?”  The answer: “Not much—just listen well.”  Not everyone wants to speak, but everyone wants to be listened to if there is no agenda other than to become known by another person. 

It’s hard to imagine who Hector might have ever spoken to before in this way.  Not his peers or jailers, for whom vulnerability is a sign of weakness to be despised or exploited.  Not the people at the shelter, who saw him as a chance to save a soul for Jesus.  It drove home for me again how universally we desire simply be known, respected, and loved as the human beings we are at our core.

Albert King’s blues classic “Born Under a Bad Sign” begins:

Born under a bad sign, I been down since I began to crawl

If it wasn’t for bad luck, I wouldn’t have no luck at all

Like many people, I often reflect on why I was born into my time, place, and family.  I’ve had my challenges, but relatively speaking I won the lottery.  Hector did not.  One theme that ran throughout our conversation, though never explicitly stated, was, “I’m trying to be a good person.  What did I do to deserve this?”  I don’t think he did anything, but that doesn’t really answer his question.

I don’t believe I deserved or earned my good fortune, which leads me to a place of gratitude for God’s grace.  But what is the counterpart for misfortune?  How does one forge a trusting relationship with one’s creator when born into such grim circumstances?  I don’t have any answers to these questions, either.

I know that many who are born into such circumstances nevertheless do form faith.  I wonder about the experiences and/or environmental factors that make such faith possible.  I wonder how someone in Hector’s situation could come to believe in a loving God that wants the best for him.  I see God’s light burning beautifully within Hector, in spite of all his suffering, but I wonder what it would take for him to see it and believe in it himself.

Despite not having answers to these questions, this is the work to which I most feel called.  Maybe a lack of answers is an essential prerequisite to doing this work well.

Unfinished Business

Gordon is in his 80s, with advanced metastatic cancer. He has moved to “comfort measures only,” but he retains a razor-sharp mind.  He was an engineer by trade but is a scientist by disposition:  he asks thought-provoking questions and follows the evidence where it leads him—including, in his case, to Christian faith.  In our first conversation, after sharing a story of a vision of heaven, he said, “Some people might call me crazy for believing in something like this.  Do you?”  I said, “If that is your experience, who am I or anyone else to argue with it?”  He replied, “It’s my truth.”

During that first conversation, Gordon spoke lovingly of his developmentally disabled daughter.  He had taken care of her for several years after his wife died, then helped her transition to the group home where she now lives.  He also briefly mentioned a son.  I knew from social work notes that his son had misappropriated funds intended for his daughter, and that Gordon had recently assigned power of attorney to a trusted niece to recover these assets and oversee care for his daughter.  I saw no opening to ask Gordon about this, and he did not go there, so I honored the dictum to “trust the patient to say what they need.”

When I look in on Gordon a few days later, he tells me he is in “incredible pain” and that he had just received morphine.  I return that afternoon to find him lying flat in bed, eyes only slightly open, but eager to resume with his theological questions.  We discuss a few, then the conversation takes a turn.

“You know how Catholics say that the only way a confession can be effective is if you confess to a priest?  What do the Protestants say?  Does a confession have to be made to another person?”

“There’s many kinds of Protestants, and I’m no expert.  But my personal belief as a Christian is no—I know of nothing in the Bible that says confession can’t be made directly to God.”  He nods.  “Still, some people find it meaningful to also share with another person.  Is there something on your heart?”

He stares off silently for several moments.  “No, there’s nothing I can do about it at this point anyway.”  He lifts his arms off his chest, slowly runs one hand over his other arm, then switches hands and repeats.  “I’m getting really old now.  My arms are so weak.  I can’t move my legs at all.  I’m in pain a lot of the time.  I’ve even lost my sense of humor.”  He smiles noticeably.

“I’m not buying that part about the sense of humor—you couldn’t hide that smile.”  He smiles again.  “But I hear you on the rest—I can see that it is true.”

“It is so much work just to stay alive right now.  But I need to do so until I’m sure my daughter’s money is returned to her, until I know she has what she needs to live on.  That’s what’s keeping me working at staying alive.”

“What are you hearing about how that is going?”

“I talked to my niece today, she said it is very close to getting done.”

“That’s good news—I’m sure that will be a relief to you.”  He nods.  His energy is dissipating, so I move to close.  “Gordon, when we spoke the first time, you told me about your daughter’s vision of heaven, and the comfort that it gave you about your own life after death.  Is that still comforting for you?”

“Yes, very.”

So we closed with a time of prayer:  honoring Gordon’s loving care for his daughter, asking for strength to conclude his unfinished business, for peace to accept what he cannot change, for the fulfillment of his vision of heaven—and with a shared smile, wishing God luck in answering all of his questions.

I learned early in my adult life that, within limits, the human will to live can push back the moment of death.  I was 20 and working on a project 2000 miles from home when my mother was diagnosed with lung cancer and given six months to live.  My mom and I shared long phone calls over the few weeks it took to complete my project; I left to drive home the day it concluded.  Taking turns with my brother, also living on the west coast, we drove straight through in less than 48 hours.  Upon arrival we learned our mother’s health had deteriorated right after our departure, and, we were told, “she’s holding on by a thread, just waiting for you two to arrive.”  We hurried into her bedroom and said our good-byes.  She died that afternoon.

Stories like this are common in the literature, and in my experience.  The theme that runs through these stories is “unfinished business.”  Many people, upon receiving a diagnosis that sets clear limits on their longevity, are encouraged to “put their affairs in order.”  This means different things to different people, of course, and is easier said than done.  Not all items on a person’s “bucket list” can be checked off.  Difficult family conflicts, built up over many years, may be impossible to resolve in the time allowed.  As time grows shorter priorities often change.  If a desire seen as truly essential seems within reach, people like Gordon and my mother will put great effort into staying alive, and if it is accomplished will then let go and pass quickly.

But what about affairs that cannot be put in order, especially ruptured relationships that cannot be repaired?  I never learned the story of how Gordon’s relationship with his son broke down—the series of events that led to him battling his son in court while on his deathbed—but it had to have been painful.  I can only speculate, but Gordon may have felt remorse over some of his own actions that contributed to this situation, and in his questions about confession he may have been seeking a way to find forgiveness.  I take no umbrage that Gordon didn’t choose to share his thoughts with me, but I hope he felt clear to take it up directly with the God he loved so much.

A lifetime is never enough time to take care of all of our unfinished business.  The sooner we get started, while time seems abundant, the less we will have to put in order when time is short. But it is still not enough—there are likely always matters about which we feel, “there’s nothing I can do about it at this point.”  We need to make peace with the knowledge that some of our most cherished hopes will remain unfulfilled when we die, and find a way to be reconciled with ourselves, and with our creator, for the work we could not manage to complete.

Inside the Waiting

Photo by Martin Lostak

Most days at my hospital the Spiritual Care team receives requests for prayer prior to a surgical procedure—some major, some minor. After experiences like the one I related in Once a Parent, Always a Parent, I now make it standard practice to offer prayer for anyone accompanying the patient, knowing that the waiting can be as difficult and anxiety-inducing as having surgery oneself.

My friend Elissa Altman, a wonderful and widely published writer, wrote a reflection last spring that captures the experience of waiting for a loved one in surgery with gritty accuracy, honesty, and vulnerability. I have been looking forward to sharing it with you all ever since, and it now feels like the time is right. With no further ado, here is the link to her essay, published in the prestigious Orion magazine. I encourage you to explore Elissa’s writing more deeply—you will be well rewarded.

Inside the Waiting (click to view essay on the Orion magazine website)

Magical Thinking

During ICU rounds I learn that Louis, in his 70s and with a long list of health issues, collapsed at a restaurant two nights earlier and was taken to the hospital.  As complications mounted, Louis requested to move to “comfort measures only”—ending all treatments intended to prolong life—over his wife Esther’s objections.  Esther was expected to return mid-morning, and the ICU staff requested chaplain support in navigating this situation.

When I get to the ICU, I find that Esther has just arrived and has already gone into Louis’s room.  Speaking first with his nurse, I learn Louis completed advanced care documents a few years ago that are consistent with his request.  Given this, and the fact that Louis remains fully coherent, Esther has no legal standing to object to his decision. 

I enter the room and I am greeted warmly by both Louis and Esther.  The nurse enters after me and starts implementing comfort care measures.  Louis’s eyes are mostly closed; he appears calm but laboring. 

Esther begins.  “We have three children and seven grandchildren.  Louis has been calling them and saying goodbye.  There’s only one left to speak to.”

Louis looks toward me.  “I just can’t go on … I don’t want to keep trying.”

“But, Louis, you promised me ten more years!” Esther pleads tearfully.  “You promised me I would be the one to go first.”

“I know I did, but I just can’t do it.”  He closes his eyes to rest.

Esther and I take seats off to the side for a few minutes.  She tells me about Louis and about their life together.  She then turns to his nurse, who has been adjusting equipment on the other side of the bed.  “He seems sleepy.  Are the painkillers making him that way?”

“Oxycodone can cause drowsiness, but we have also stopped the meds that have been keeping up his blood pressure, among other things.  Louis is now entering the phase of active dying; his body systems are shutting down and he will become quieter.  He appears comfortable, and we will keep him that way.  He seems very clear of mind—unusually so for this stage.”

“Oh, you should see him when he is well—he has as sharp a mind as you will ever see.”

Esther and I turn back toward each other.  “What makes this so hard is that our son, who we live with, was recently diagnosed with terminal liver cancer.  He is only 40!  This is all just happening so quickly …”

“I’m sorry.  That is so hard, and you have had so little time to process things since Louis collapsed.”

“Now we are having conversations that we probably should have had years ago.  He’s had health issues for a while, but I didn’t expect this.  I just don’t understand why he seems to have lost the will to live.”

“From everything you have told me, and what I have seen myself, Louis is a very strong-willed man.”

“He certainly is … very much so.”  After a long pause, Esther continues.  “Maybe his body just won’t let him keep going.  Louis always says he doesn’t understand why people make such a big deal out of dying, when we know we are just going to a better place.  That’s what he believes … and I believe that, too, that’s our faith.”

Two nurses come in and prepare to sit Louis more upright in his bed, to make it easier for him to make his final call.  I conclude my visit, and later learn that Louis died 45 minutes after I departed.

I recently read Joan Didion’s memoir The Year of Magical Thinking, which chronicles her grieving process following the sudden death of her husband of 40 years.  There are several parallels with the story of Louis and Esther, including Didion’s grief being complicated by a life-threatening illness that befell her daughter one week prior her husband’s death.  Important differences, too—Didion never had the opportunity for final conversations with her husband.

The most profound parallel, though, is the extent to which both women refused to entertain the imminence of their husbands’ deaths despite abundant foreshadowing.  Didion recounts conversations with her husband that began and ended:

“If something should happen to me …”

“Nothing is going to happen to you.”

Louis’s health concerns were sufficiently severe that he had completed a POLST (Portable Orders for Life Sustaining Treatment), usually used only in cases of advanced illness.  Despite this, Esther persisted in the belief that Louis would live ten more years, and Louis entertained this magical thinking until he could no longer do so.  Esther’s remark, “Now we are having conversations that we probably should have had years ago” was an understatement—during what turned out to be their final hour together, they were just broaching topics such as cremation vs. burial and what kind of memorial service Louis wanted.

Denying the imminence of death is, of course, hardly uncommon.  Even if Esther and Louis had prepared themselves better for Louis’s collapse, Esther’s pain of losing her husband, and the dread she felt for losses yet to come, would be excruciating for anyone in her situation.  It was heartbreaking to sit with her as this new reality began to settle in.  As in my earlier essay Dying is Often the Easy Part, Louis was on the cusp of being released from suffering while Esther’s journey was only going to get harder—and she would have to manage it without Louis, her soulmate for more than 40 years.

One of my primary motivators for this Elder Chaplain project is my belief that normalizing conversations around mortality, especially with our loved ones, can mitigate the distress of a serious health crisis—whether ours or theirs.  In particular, by helping to dispel the magical thinking about immortality that we all can be subject to, engaging in these conversations when we are healthy can help us be more fully present with each other when we arrive at a time of need. 

As the new year dawns, I am grateful for you, my readers, who through your support have joined me in these conversations about mortality.  In the coming year I hope to engage with you more directly, and to bring your voices and experiences into this conversation, so that together we can grow in wisdom.

Hoping Against Hope

“All I know is that six days ago I was perfectly fine, then I had some tingling in my feet, and now I can’t even walk.”

I hold the hand of Rachel, a 40-year-old woman, and absorb the story of her mysterious illness.  I listen to her describe the light of her life, her 18-month-old son, Joseph, and speak of her maternal grandfather, now deceased, who inspired her son’s name.  I create room for her to sob as she tells me how much she misses them both right now.  Near the end her mother, Sally, joins us, and together we pray.

Dear God – We pray for your deep sense of presence as we gather in your name.  We ask for wisdom for Rachel’s doctors, that they might discover the cause of her affliction and restore her to health.  Please comfort her heartache for those she is missing, and grant her peace as she awaits your healing touch.

“If you could come see Rachel today, it would mean the world to her.  She told me you remind her of my father, that you comfort her the way he always did.”

Sally has stopped me in the hall; while Rachel’s unit is not on my rounds today, I accompany her back to Rachel’s room.  Rachel’s husband, Dan, is feeding her lunch, as Rachel can no longer lift her arms.  We speak briefly and agree that another time might be better.  Back in the chaplains’ office, I look up Rachel’s chart and see a new working diagnosis:  Guillain-Barre Syndrome.

Dear God – What a terrible condition to befall Rachel.  I’m sure it grieves you even more than it does me.  Please give her strength to battle her condition.  Help me, too, to be the chaplain she deserves.

“Rachel appreciates your coming, but she’s too exhausted to see you—she just needs to rest.  She’s a real fighter, though—she’ll get through this.  We have her church and ours praying for her recovery.”

Sally has intercepted me outside of Rachel’s nursing unit.  I ask Sally how she is holding up.  Her lip quivers, but Sally’s a real fighter, too.  She says they just need to get Rachel’s sodium levels back up and she can move to the rehab clinic to rebuild her strength.  I review her chart and confirm this prognosis.

Dear God – It’s been more than a week now, and the light at the end of the tunnel seems always around the next bend.  I know you are doing your best—Rachel’s family says they feel your presence at all times.  Please bring strength to them all—and to me as well—to be ready for whatever may be required.

I check the census and find Rachel in the ICU.  There, I find Sally, Dan, and Rachel’s sister gathered to one side of Rachel’s bed.  Sally waves me in, then collapses in my arms.  I close my eyes to feel her pain, then open them.  I see Rachel asleep in her bed—unmoving, intubated.  Dan and Rachel’s sister look on with me, in stunned silence.  Sally lifts her head to speak.

“The good news is she is finally getting some deep rest.  The doctor was just by and said her labs were a bit better.  We might have hit bottom at last.  We just have to hope.”

Sally thanks me for coming, then takes another long hug.  It is afternoon before I can chart my visit.  I learn that Rachel has been transferred to the ICU of a big hospital downtown, which her doctors feel can better address her continued deterioration.  And that is all I will ever know of Rachel and her family.

Dear God – What work this is that you have called me to?  You bring me into the midst of deepest pain, which I can do little to relieve, then pull me out without resolution.  You teach me that accompaniment is my primary medicine, but that I am only one thread in the fabric of care.  I must trust you to heal what I cannot, and I must accept that my care, while it feels insufficient, is nonetheless all that you ask of me.

◊ ◊ ◊

This story, now three years old, still chills me.  As I said in an earlier essay, Practicing Hope, it can be so difficult to be fully present to and engaged with loss while, at the same time, not losing faith that light remains in the darkness.  I draw inspiration from Sally’s continued expressions of hope, which were not simplistic wishful thinking but rather a powerful, determined search for light, for the strength to move forward despite daily discouragements. 

Hoping against hope, when our desired outcome seems increasingly remote, requires us to shift our focus away from that outcome toward a goal that feels more achievable.  If not improvement with symptoms, then perhaps an improved lab result.  If not restoration of the ability to walk, then perhaps increased ability to navigate by wheelchair.  If not remission of cancer, then perhaps reduction of pain and the peace of acceptance.  Hoping against hope is an imaginative reframing of goals within the context of what seems possible in order to restore a sense of agency to those who are suffering.  It is the opposite of giving up hope—it is an accommodation to reality that allows us to continue to hope.

To my mind, this is difficult work to do alone.  The accompaniment of others in our darkest moments can pull us out of a vortex of discouragement and help us consider more broadly the spectrum of possibilities.  The world’s great religious traditions do much the same by placing our personal crises in a larger spiritual and historical context, and by inspiring us with examples of others who have maintained hope despite equally difficult circumstances.

When supporting someone confronting a situation that feels hopeless, our task is to walk a fine line that neither encourages false hope nor discourages the work of hoping.  Often that is best accomplished just by being present, listening to and acknowledging the difficulty of the situation, communicating our love, and supporting the person in their work of evaluating and reframing their goals.  And, if one is a person of faith, trusting that God is present and active in all of this work without ever presuming that we know the outcome.  If we can show up and do this, we will have done our part.

In these shortest days of the year, as many of us prepare for the long winter ahead, it can be difficult to find reasons for hope. Yet we often find it in the unlikeliest of places, including among those whose suffering is greatest.  For me, the most profound message of Christmas is this:  the light shines in the darkness, and the darkness has never overcome it (John 1:5).

Once a Parent, Always a Parent

My first patient for the day—Ruth, a Christian woman in her early 60s—had asked for prayer before surgery, a common request.  When I parted the curtain surrounding Ruth’s gurney in the surgery prep area, I noted a second, older woman seated on the far side of her gurney.  After Ruth and I exchanged greetings, she introduced me to Naomi, her mother.

“I’m having a lumpectomy,” Ruth began, returning her focus my way.  “I’m feeling good about it—they caught it early, and the tumor is small and well contained. They say they should have no trouble getting it all.  But prayer always helps me …”

As usual, I asked Ruth a couple of questions about her faith and what prayer means to her, then I took her hand and offered prayer in language familiar to her, asking for God to bring peace to her heart, to guide the work of her care team, and to provide comfort and healing in the aftermath.

“And God, please also bring peace and comfort to Naomi as she sits in the waiting room.  Sometimes the work of waiting can be even harder, especially when it’s your beloved child who is having surgery …”

Naomi burst into tears and spoke.  “Yes, that’s it exactly.  You see, Ruth is all I have now.  My son died tragically only six months ago.  I just couldn’t bear to lose Ruth, too …”  Ruth turned on her gurney to look over at Naomi, then reached out to take her hand, with seemingly newfound appreciation of her mother’s vulnerability.  I offered my hand to Naomi and she took it, completing the circle.

“Dear God, thank you for your gift of parental love, which endures forever and never gets easier.   You know what it means to watch a grown child suffer.  Please help Naomi to feel your strong presence as she waits while the surgeons do their healing work.  May she draw comfort and strength from knowing of your steadfast love and care—for her, and for Ruth .”

As adults, we can be remarkably oblivious to our parents’ never-ending concern for our well-being.  We are so determined to demonstrate our ability to manage life without their help that it can be irritating to watch them continue to try.  A few years after I had my own children, I listened as my father expressed concern over a challenge my younger sister was dealing with.  “Dad,” I said with obvious exasperation, “she’s almost 40!  She’ll figure it out.”  He calmly replied, “You’ll understand …” 

In many families, as adult children and their parents continue to age, the balance inevitably shifts, and the children become increasingly concerned with—or actually responsible for—their parents’ well-being.  Members of the “sandwich generation”—caretaking parents while still raising children—can’t help but draw parallels between the two, and it’s easy to forget that the parents were once the responsible ones in the family.  But the parents never forget …

My own children are nearing 40 and have gone through their own crises as adults, and I now understand what my father meant.  Once a parent, always a parent.  As the song from Love You Forever concludes, “as long as I’m living, my baby you’ll be.”  If a child of mine needs surgery at age 60 and I’m still around, I’m damn sure going to worry about it, and I’ll try to be by their side even if they think I’m being ridiculous.  I just can’t imagine ever being released of my concern for my children.  Neither could Naomi. 

The death of a child at any age is among the greatest losses a parent can endure.  The gaping hole in Naomi’s heart created by the death of her son was raw and tender—he will be her baby for as long as she lives.  The thought of losing Ruth as well was simply unbearable.  Ruth was likely also the cornerstone of Naomi’s support network for the final years of her life, bringing additional terrifying implications.  As it turned out, Naomi’s fears prior to this surgery were far more profound than Ruth’s.

Some people believe prayer prompts God to intervene on their behalf, though many do not.  More often, as for Ruth and Naomi, prayer serves as a means of connecting to a power larger than oneself, to the creative force that gave rise to our being and never stops caring for us.  Preparing for surgery that day, Ruth and Naomi were not seeking intercession but accompaniment.  Each, in their own way, wanted to know that their fears were understood and empathized with, that the ultimate loving parent would be holding their hands in their time of need—and that the bond of parental love endures all and is never outgrown, even in death.

Richard and Elizabeth

“Good afternoon, Richard, my name is Greg,” I say in greeting to the gentleman in Room 901.  “I’m a chaplain here.  I’m making rounds and offering company, conversation, prayer to anyone …”

“HE CAN’T HEAR YOU,” the woman seated at his feet shouts.  “You’ll have to stand closer.”

I walk over to the right side of the bed, lean over gently, and repeat my introduction in a clear, strong voice.

His face lights up with a smile.  “That’s so nice,” he replies.  “I’m a Christian—an Episcopalian—and I love prayer.  I could use some prayer today.”

I glance in the direction of the woman, and he lights up again.  “That’s Elizabeth, my wife.  We’ve been married 72 years.  Can you believe that?”

I rise and cross over to greet her.  She shakes my hand, then pulls me close to speak in a quieter tone. “My hearing’s not so good, either.  What did he just say?”

“He said you have been married 72 years.  That’s wonderful!”

“Well, it’s mostly been wonderful.  We get on each other’s nerves sometimes.  But I suppose that’s true for every couple.”

I agree, and return to my place by Richard’s side.  “What would you like me to pray for today?”

“I just want to go home.  I can’t even remember why I’m still here.”

“You had your hip replaced this morning.”

“I did?”

“Yes, you did.  I overheard your son speaking with the doctor.  It went very well, you just need to rest and heal up a little more before you can go home.”

“Well, OK, that makes sense.  So how about that prayer?  What kind of pastor are you, anyway?”

“I’m a Quaker.”

“A Quaker?  Well, now isn’t that something!  Did you hear that, honey, he’s a Quaker!”

“HE’S A WHAT?”

“I’m a Quaker,” I repeat, speaking directly toward her.

“So give me one of your Quaker prayers, then,” Richard requests with a smile, then closes his eyes.

I speak as loudly as I can muster.  “Dear God, thank you for your faithful servant Richard, and his wife Elizabeth.  Thank you for the way you have blessed them with each other’s love for the past 72 years.  Please fill Richard’s heart with your presence, and grant him the peace and patience he needs to heal.  Bless them and protect them as they journey home, and for all the rest of their days.”

Richard opens his eyes brightly.  “I never heard a prayer like that before.  I like that Quaker prayer!”  He turns toward Elizabeth.  “Honey, wasn’t that a wonderful prayer?”

“I COULDN’T HEAR A WORD HE SAID!” she replies.

While many patient visits are challenging, many others are uncomplicated and joyful, and leave me with a smile on my face and a spring to my step. Experiencing the love of long-term couples, especially when the honey is sharpened with a little vinegar, is one of the best parts of this work—and of life!

A Chaplain’s Prayer

The admin assistant for the Spiritual Care team strode briskly into the shared chaplains’ office.  “The ED (Emergency Department) just called.  A man in his 70s died in the ambulance on the way here.  Family has been notified, and it sounds like a bunch are heading this way.  The ED hopes you can get down there by the time they arrive.  That’s all we know.  Oh … and he is a Sikh.”

I began my second internship at the peak of COVID’s Delta surge, and all of the other chaplains were out on the floor.  With trepidation, I grabbed my notebook and headed down the corridor.  As I entered the waiting room I saw a large group huddled in the middle (I later counted eight).  The nurse in their midst looked at me with relief and escorted us back to a large ED room.

The deceased man, Aman, was lying in repose on a gurney.  A few women rushed to his side, weeping; the others stood at a slight distance, looking on.  I, too, stood at a distance, uncertain how to offer support. A man approached me, thanked me for being present, and proceeded to explain the relationship of each person in the room with Aman.  With that, I became one of the family, and soon others welcomed a bit of conversation.

I learned that Aman was a larger-than-life figure in his family and in his first-generation immigrant community, a classic patriarch.  He’d had health challenges for years, but lived each day with such vigor that no one saw his death coming.  I learned another son was on his way to the hospital, but it would be at least an hour before he arrived.  Someone asked, “How long can we stay in here?” and I realized I had no idea.

I stepped out of the room to check at the main desk.  I noticed that the aisles were packed with people on gurneys, all waiting for a room, and I knew I had my answer.  The charge nurse was sympathetic to the situation, and together we concocted a plan to move Aman upstairs to a private chapel where family could remain without time pressure.  “You still have a few minutes before we’ll be ready to move him.”

Back inside, I observed as many ways of responding to the death of a loved one as there were people in the room.  Aman’s daughter, overwhelmed with grief, pleaded to Aman to wake up and refused her aunts’ entreaties to gather herself.  Aman’s son, now thrust into the role of patriarch, sat numbly to the side, then was escorted out of the room by an uncle to find a funeral home that could accommodate the family’s religious practices.  A brother-in-law waxed philosophically that “this passage is a journey we all must take.”  A sister shared, “He was a true salesman—you would come in to buy socks and leave with a suit.”  As she laughed aloud at this memory, her sister scowled and said, “How can you laugh at a time like this?”  In other words, a family like any other …

There is no preparing for the moment when something unexpected or long feared suddenly, irreversibly, comes true.  There is no way to anticipate how we will respond, nor is there a “right” way to respond.  When tragedy strikes, we find ourselves without a script.  What we need in that moment is the freedom to feel what we feel, and to express those feelings in whatever form they take.  It helps to have an active listener who can offer affirmation, not judgment.  Those who are similarly devastated by the tragedy rarely have the capacity to listen in this way; they are dealing with their own emotions.  This is a situation where a chaplain can be especially helpful.

This particular chaplain, however, was confronting his own long-held fear.  I had just started back into chaplaincy after a one-year hiatus; this was a scenario I had always dreaded might arise, and I had no colleagues to look to for support.  Actually, I realized, I had one.  As I started down the hall toward the ED, I took a deep breath, and a prayer rose from within.  “Dear God, please help me to be who you need me to be in this moment.”

I have come to call this my Chaplain’s Prayer, and I now recite it regularly when I sense that a situation will be challenging.  It helps me remember that the guidance of the Spirit is always available if I can stop overthinking the situation—treating it like a problem I have to solve—and instead create a place of peace in my center from where I can discern what is needed and offer it.  This prayer was a wonderful gift to me that day.

As the family gathered around Aman’s body, I wondered briefly if I should say something, though nothing appropriate came to mind.  I took a breath and received the leading, “This isn’t about you!  Stand back and let them find their own ways to experience this.”  I recalled one of the mantras from my training:  “Trust the one suffering to know what they need.”  And so I did. 

One family member sought me out to reflect on his own mortality.  One found comfort in sharing stories of the deceased.  One shared guilt that she hadn’t gone to Aman’s apartment that morning when he didn’t answer her call, that if she had he might still be alive.  One wanted practical guidance on choosing a funeral home.  Aman’s son, when he returned, just wanted to be held and hugged as he sobbed, finding no such offers among his own family.

As I now understand my Chaplain’s Prayer, what God needed from me in that moment was simply to be available and attentive to each family member, and to offer what they needed as best as I could.  It doesn’t seem like much, yet that day it was more than enough.

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Dying is Often the Easy Part

Marge was in her late 80s, hospitalized for congestive heart failure.  When we first met, she was being attended to by her daughter, Karen, who welcomed me in.  “Mom’s doing better today.  She’s active in her church, she’ll be happy to see you.”  We settled in for a nice conversation about her family, her faith, and her friends, and Karen and I departed together.

When I returned two days later, Marge was in her bedside chair wearing a bright lilac print dress—a sure sign she was being discharged.  I commented that it looked like she was having a good day.

“Oh, yes!” she exclaimed.  “The doctor came by this morning and said there is nothing more they can do for me.  I’ll be going home very soon to Jesus, and to my parents, and to all who have gone before me.  It’s so exciting, I can hardly wait!  I’ve been on the phone telling all my friends.”

What can one say to that?  One might or might not share Marge’s theology, but her joy was infectious.  Wouldn’t we all hope to be so positive nearing end of life?  I joined in her celebratory prayer and wished her a good journey.

On the way back to my office I ran into Karen coming off the elevator.  “Have you seen my mother today?” she asked anxiously.  I told her I was just coming from her room, and that we’d had a good visit.

“Really?” she asked.  “Because she’s calling all her friends and telling them she’s going home to Jesus now.  They are freaking out, and I am, too.”

“I think you need to go talk to your mother” was all I could say.

If there is one lesson chaplaincy teaches endlessly, it’s that we can control or change so little.  I might have once thought a chaplain’s job was to say something transformative, but it’s much more about presence and listening.  Rather than feeling the need to be a font of wisdom, we need to trust the patient (or loved one) to know what needs to be said, and to leave them feeling deeply listened to and validated.  With rare exception, a chaplain fixes nothing.

It’s a helpful lesson, especially when dealing with mortality—the “problem” that can’t be fixed.  Whether through instinct or culture, though, we keep trying.  When the topic is our own existence, we tend to ask for whatever treatment is most likely to prolong our life.  At some point, though, for most people, death’s inevitability becomes clear, and we become reconciled to our inability to change the outcome.

When the life on the line is that of a loved one, though, it can be much harder.  We don’t feel our loved one’s pain or exhaustion. We don’t go through their deeply personal evaluation of the struggle to keep living vs. the possibilities of what lies beyond death (even if simply nothingness).  We focus instead on our own dread of the loss we see coming—perhaps because we have never known such a loss, perhaps because it conjures up painful losses from our past.  It’s a brutal reminder that life brings suffering that we are powerless to prevent.  It cannot be fixed.

What we can do, as a chaplain or as a loved one, is accompany.  We can try to be present to the other’s reality, to give them space to tell us difficult things, to help them feel known the way they want to be known.  I understand why Marge’s daughter and friends didn’t want to hear what Marge had to say, but that was Marge’s reality at that time and she wanted company in her joy.  This, at least, I could offer her.

I’ve often wondered how the conversation went after I parted with Karen by the elevator.  I wasn’t invited to join that conversation, and it wasn’t my job to insert myself. I have to trust that they could lead each other to where they needed to be.  I have my hopes, but I will never know.  I rarely do.

Practicing Hope

James was a middle-aged man whose metastatic cancer had caused paralysis below the waist.  When we met, he spoke of his leadership responsibility for his extended family, including children, grandchildren, and his younger siblings.  While acknowledging the possibility of dying soon, he felt his purpose in life was to heal and rehabilitate so he could resume his responsibilities.  To do anything less felt like failure.

James began treatments for the cancer causing his paralysis, but these made eating intolerably painful and he began wasting away.  He shared how deeply this scared him, but it didn’t weaken his resolve.  James reflected thoughtfully on how humbling his illness was, but also on the life lessons it was teaching him.  He wanted to capture them all to share with his loved ones during his remaining time on earth.

James was no stranger to hardship.  His family of origin was large and poor; his mother exuded love for God, but James fell into gang life.  James shared, in a matter-of-fact way, about being on the receiving end of bullets shot with the intent to kill, and about renewing his relationship with Jesus while in solitary confinement.  By his thirties he had earned his release and begun the life of a working family man.

The seeds of faith within James grew stronger as he confronted his illness.  He began speaking openly about his mortality, slowly building his trust in God to care for his loved ones when he could no longer do so.  At the same time his faith also intensified his will to push through pain toward recovery.  James began making steady progress, putting on weight, then walking a few steps, eventually climbing stairs.

As the prospect of discharge to home came into view, James wanted to explore “a new kind of prayer”—one that felt truly authentic, not formulaic.  Above all, he wanted to express gratitude for his life—not just the domestic life he looked forward to going home to, but every step of the journey that made him the person he is today.  He had come to embrace himself fully as a child of God.

I adopted the tagline “Practicing Hope Amid Loss” for many reasons.  Hope, like gratitude, is a muscle that develops strength with practice.  Krista Tippett adds, “[Hope] is not wishful thinking, and it’s not idealism.  It’s an imaginative leap.”[1]  The challenge of our elder years, it seems to me, is finding that place where we can be fully present to and engaged with loss while, at the same time, not losing faith that light remains in the darkness.  Some days that feels like quite the imaginative leap.

My eight visits with James, spread over four weeks, gave me a master class in practicing hope.  Since the onset of COVID our family has endured one health crisis after another, and sometimes I have struggled to imagine positive outcomes.  After one of these crises hit, my supervisor commented that it would be entirely understandable if I needed to take some time away from chaplaincy.  But I was finding that chaplaincy work was helping me keep my situation in perspective, even inspiring me.  Shortly thereafter I met James, and for that I am forever grateful.  He turned out to be just what I needed.

My training taught me to keep my situation “out of the room,” to focus fully on James and get my own needs met elsewhere.  It wasn’t difficult—James’s life experiences were so far removed from mine, and his personality and needs were so intense, that there wasn’t room for me in that room anyway.  Later, reflecting quietly, I could see how he was raising and addressing many of the same questions and fears that had been filling my mind.  He not only challenged me to adopt a posture of hope, he showed me what it looked like to practice hope in the midst of loss.

In the end, James’s hope bore fruit:  he received what he had been seeking—more time with his family.  In the end, I have been blessed, too—our health crises have left their mark, but our spirits have been strengthened.  Many situations we confront as chaplains—and as humans—seem to have no possibility of a happy ending.  I believe it is good for us to build up our muscles of hope whenever we can so that they may become a source of strength when the loss that surrounds us becomes deeper.


[1] Krista Tippett Wants You to See All the Hope That’s Being Hidden, NY Times, July 10, 2022.