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.

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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.

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)

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.

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.

“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!

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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On the morning of my first day of chaplaincy internship, I knocked on the first door of the unit to which I had been assigned.  After a pause, I opened it to find Ann, a woman in her 60s, sitting in bed, staring at a plate of scrambled eggs.  She looked over at me, expressionless, and asked me to come back after she’d had time to eat breakfast.  I agreed and departed, excited that someone actually wanted to talk with me.  When I returned 20 minutes later Ann motioned toward a chair near her bed.  I sat down and she began.

“I’m here because my kidneys are failing.  I’ve been on dialysis for years, but that can go on for only so long.  I’ve been on a transplant waitlist for more than a year, but apparently I’m a difficult match.  One of my nephews turns out to be an excellent match, and he eagerly agreed to donate.  I came in yesterday for workups in preparation for a transplant.

“Just before my breakfast arrived, my doctor came in to tell me that my health has deteriorated to the point that I am no longer considered an acceptable risk for a transplant.  There’s nothing more that can be done beyond helping me to live out my remaining time comfortably.”

“I’m so sorry to hear that,” I replied.  “That’s really difficult news to get.  I’m here for you in any way you would find helpful.”

In a flash Ann was painting vivid images of herself as a little girl growing up on a farm.  Dreams of becoming a veterinarian that evolved into a career as an industrial scientist, breaking glass ceilings along the way.  Dreams of finding true love that never came true, “just a bad marriage that I had the sense to get out of quickly.”  Dreams of having children of her own that were replaced by a bevy of nieces and nephews who adored her (including the aspiring kidney donor).  Close friends who had supported her throughout her illness, and were prepared to support her for the rest of her days.

“You know, as I listen to myself telling you all this, I realize it’s been a great life,” Ann said through tears.  “I’m sad that it’s coming to an end, but I really can’t complain—I have a lot to be grateful for.  Thank you for taking the time to listen.  It’s made today’s bad news easier to bear.”

Before I stepped into Ann’s room, I had grand, if vague, notions of what being a chaplain would feel like.  I had learned many dos and don’ts, and how to chart a visit in the medical record.  I don’t think anything could have prepared me, though, for the reality of sitting in Ann’s chair and hearing her news.  I said to myself, “You said you wanted to be a chaplain.  I don’t know what you were thinking, but it’s ‘Game on’—right now.”

At any rate, Ann was the perfect first patient for me.  Her plight stirred my heart but did not overwhelm me, and it took no effort to draw her out.  She was bright, reflective, and insightful, and she glided easily between happiness, wistfulness, pride, sadness, and gratitude as she told the stories of her life.

Fortunately, the essential elements of chaplaincy are compassionate presence and active listening, and most of us come equipped with at least the basics.  There is more than I ever realized to practicing these well, and either can be hard to do in a given situation, but most of us practice them regularly with family and friends.  I am often surprised when people say, “I could never do what you are doing,” when I have watched those same people do this work beautifully—including with me.

As I closed the door on my way out, I told myself, “OK, I wasn’t so bad.  In fact, it seems I was helpful even if all I did was listen.”  I went back to my office to chart my visit.  I reviewed a list of descriptors of what I had helped the patient explore, and I checked a box marked “Life Review.”  I thought, “That must happen a lot,” and subsequent experience has proved that true.  I looked over other descriptors, such as “loss of loved one” and “patient actively dying,” and thought, “These must all happen a lot.”  Also true, I now know.