It requires more courage to suffer than to die.
Napoleon Bonaparte
Life can seem capricious:
• A lively young woman hops into the car to run an errand. Four minutes later she's dazed and injured, looking into the anxious eyes of rescuers from a pile of twisted metal and broken glass.
• A gray-flannel-clad executive clutches his chest and falls to the city street amid the litter — a victim of a heart attack.
• A rambunctious high school linebacker lowers his head to spear a ball carrier — and spends the next year immobilized and the rest of his life a quadriplegic.
• A new bride develops weakness in her legs and then goes suddenly blind. Extensive tests determine multiple sclerosis the culprit.
Each event was unexpected, unwanted, a crisis. Into these experiences pastors are called.
Sudden Incapacitation
Medical considerations. When injury or disease strikes, medical attention must be the first concern. Writes Eugene Kennedy, professor of psychology at Chicago's Loyola University, in Crisis Counseling, "The first common-sense rule, echoed in cliches like 'stand back' or 'give them air,' is the priority of getting adequate medical attention before achieving any other goal. One may be more inclined to handle the emotional aspects of the problem, but this is surely secondary when one is involved in an obvious physical emergency."
At the early stage of trauma, emotions enter in mainly in the realm of hope, the will to survive. Any physician can tell of people who gave up the will to live and died of injuries or illnesses they could have conquered. They will also tell of people who through pure grit and determination beat the odds and survived. The determining factor: the will to live.
How is the will to live encouraged? By giving a reason to live, and that can be communicated by love, family support, reminders of life beyond the trauma. Touch communicates care. Visions of the future give something to push toward. "I think of what I'm excited about living for," says one helper, "and that helps me remember what may motivate them."
How, then, is the will to live dampened? Loose lips sink ships was the poster motto from the Second World War. The same poster belongs in the hospital. "As events move along, it's important to avoid making pessimistic observations about the individual's condition, even if he or she seems to be unconscious," writes Kennedy. "Saying how bad things are, or how much worse they might get, is no help to anyone during such a critical time." Of the senses, hearing and touch are usually the last to be lost.
Isolation — the sense that no one shares the distress, no one familiar is around — affects the will. Unremitting pain saps life from victims, as does a sense, real or imagined, of nothing better in the future, nothing to live for. Dreadful weariness makes it hard to face an uncertain future. Containing or improving any of these elements adds to the strength of that all-important will to live.
Adjustments. Once a person is stabilized medically, he or she must deal with what often is a radical change in "body image." Glen E. Whitlock describes body image in Understanding and Coping with Real-Life Crises: "The body is not simply flesh and bones arranged in a unique way. If in one sense a person is more than a body, there is a real sense in which a person's body is that person. The only way we recognize people is through their bodies.… It is equally true that we perceive ourselves as particular bodies. For example, a woman relates to her body not merely as a physical organism, but also as the carrier of her total selfhood.… Any change in body image, therefore, involves an altered perception of self. It follows that the more radical the change, the greater the possibility of a radically altered self-perception, and significant changes in self-perception are usually difficult to work out."
One pastor tells of a 45-year-old woman entering the hospital for elective surgery. "She is an active wife and mother, works part time, and lends much time to charities and kids' activities. She's pretty much been able to do what she sets her mind on doing — an achiever. But severe hemorrhaging after two childbirths and continuing internal maladies have taken their toll on her kidney and uterine functions. The doctors agree she needs a total hysterectomy and extensive urinary repair. She expects to be in the hospital a week for the surgery and eight weeks at home for recovery."
Consider the crisis this brings. To this point, her body image might contain these adjectives: active, attractive, reproductive, nurturing, energetic, youthful, competent, care-giving. Think how these adjectives will change from the moment she regains consciousness in the recovery room: painful, weary, immobile, needy, dependent, barren, deprived, apprehensive, limited. She expects full recovery, but a part of her will be missing, and a lot of her energy will be gone. For at least two months, she will have a body telling her different things about herself, and even after recovery, she will deal with an altered self-image.
Pastors try to help such a person come to grips with this different body she inhabits and calls me. When recovery is full, the pastoral work takes place in the interim — giving encouragement, pointing out progress, standing beside the person in the darkest times, holding a hand, praying, challenging.
When there will be no recovery, the task is more difficult.
Consider the football linebacker paralyzed from an injury. His body image included: quick runner, rugged, star athlete, sexually attractive, dependable, and useful. In the hospital, unable to move a muscle below his neck, totally reliant on others, humiliated by his body being exposed to strangers, what's the linebacker to think about his body image? It has to undergo complete reconstruction, and as Whitlock says, that's difficult.
What's a pastor to do? "Assist the person to understand the map of the suddenly changed world," is how Kennedy puts it. The linebacker needs to hear of his prognosis, as difficult as it will be to take. He needs to know what he can expect, what he has to face, what he might be able to accomplish. He needs encouragement to keep from vegetating, for there are things he can learn to do for himself. He needs counseling to help him through the depression and bitter disappointment his new body image dropped on him. Most of all, he needs someone to listen to him, to hurt with him, to stick with him, to love him, to reassure him of his continuing value and manhood.
Longer-term care will involve physical therapy, training programs, vocational rehabilitation, nursing services, grants for education. Through all these, he may need someone to go with him.
Here pastors can help, but a church is even better. A dozen people or a dedicated few can provide rides, visit, read to him, invite him to activities, stretch him when he needs it, listen. As he adapts to his new world, it helps when that world is peopled by caring Christians.
Loved ones. The family and friends of the incapacitated also need pastors. The family of the woman in the car wreck or of the man with the heart attack will suddenly find the world turned upside down. The husband of the bride with MS faces the prospect of a life far different than what he'd planned. Major illnesses and injuries plunge a wide circle of loved ones into crisis.
"I try to imagine the needs of her family," says the pastor of the woman entering the hospital for the hysterectomy. "Her husband faces possibly losing his wife. Although it isn't probable, you know it's worried him. He will soon have all the responsibilities of the household along with the added care of his wife. He has the immense hospital bill on top of his wife's loss of earnings during her leave of absence. He'll want to help his children through this difficult time, but who will be helping him?
"The children will miss their mother and worry about her. She won't be there to fix lunches or see them off to school. There will be visits to the foreign world of the hospital, where their mother won't be the vivacious one they're used to. Then they'll have her home as an invalid and will have to care for her, a role reversal. They'll need somebody to help them with this readjustment."
Most of the care needed by families involves listening and assisting. They need to express ideas and fears. They may be angry with the person for "doing this to us," but feel terrible about thinking such thoughts. They may question the fates for causing this to happen to their family. They will be overworked and probably overwrought. A loving, listening, caring pastor can help ease this difficult transition, and a supportive church family adept at casserole baking and child chauffeuring will be greatly appreciated. Those who enter crisis to give hope where there is none, correct and well-timed information where it's lacking, support when it's needed, continuity when all else crumbles, and independence when that's possible, are blessed indeed.
Terminal Illness
Some diseases and injuries people simply do not beat. Eventually, one of them will fell every one of us. Those with knowledge of the specific one, we call terminally ill. It's a mixed blessing.
My father died in 1980 of pancreatic cancer. For several months prior to his death, he wasn't at all well. Heart problems led to coronary bypass surgery, but when he should have been feeling much better after the surgery, he wasn't. Finally, great discomfort and a jaundice-like state forced him back into the hospital. Exploratory surgery confirmed our worst fears: widespread, inoperable cancer. He was given up to six months to live. God mercifully took him within a month.
So for a few weeks, Dad knew he was terminally ill. We all knew it, and it gave us the opportunity to transact some final, hard but satisfying interpersonal business. I remember standing on a sidewalk outside the hospital grasping the hand of my toddler son and holding my infant daughter — his only grandchildren. He wanted to see them, but he didn't want them to remember him looking as he did. He waved jauntily from the hospital window; the children smiled and waved back, not knowing they'd never see Grandpa again. But he got to savor them one last time.
Another day I sat on his hospital bed, although I knew it wasn't good bedside manners. We spoke of many things — mostly good things like fishing trips and my "swinging like a rusty gate" when he taught me how to bat. We laughed. We related as men. He proudly introduced me to a physician as "My son, Doctor Berkley." When the internist started discussing medical technicalities, I had to let him know my doctorate was in ministry, not medicine.
I'm thankful I had that final time with my dad. We didn't talk about death, but we both implied it. Instead, we affirmed each other and our family and how good it was to be father and son. Because we knew of the terminal quality of his illness, we could make sure a day like that happened.
For all the beneficial aspects of knowing, there are also drawbacks. Seeing my father weakened, dependent, and fading was not easy. Realizing that berserk cells were that minute multiplying and taking life from the one who had given me life was disquieting. None of us likes to see a loved one weaken and die, so in that respect terminal disease is terribly hard. Bit by bit, death wrenches first health and then life from the one we love, and we can do nothing.
But my acclimatizing to the notion was nothing compared to my father's. I would have to learn to live without him; he would soon not be living. I worried about my mother; he felt as if he were abandoning her. I didn't like to see him in pain; he had to bear it. I had to face the notion of death; he stared the reality face to grim face.
How thankful I was for the loving and competent care of my parents' pastor, Ted! He helped my mother and father face the dragon because he stood beside them all the way. He called on them regularly. He prayed with them. He talked with them. He wasn't full of cheap answers, but costly grace. That's the role of pastor in terminal crises.
Terminal Care
How do you break the news of impending death? Or even more basic, should you tell a person he's dying? Two words enter in at this point: hope and honesty. For the critically ill or injured, hope is a vital ingredient for recovery. Kennedy writes, "Study after study has revealed that those patients whose hope is destroyed also do worst in dealing with their injuries or other illness. It is the vital stuff, the 'right stuff' indeed, at a time of physical danger."
On the other hand, many illnesses have almost certain outcomes. Barring a miracle, my father was not going to recover from pancreatic cancer. A leukemia victim in the final stages of the disease will likely not recover. People such as these have exercised a vast amount of hope, and now the time comes for honesty — our honesty with them, and their honesty with themselves.
Kennedy asks: "Suppose the person asks directly whether he or she is dying? This is by no means an unusual question, and it is not one to which we could respond with a lie or a major distortion of the facts. If, in fact, the person is dying, one can say 'Yes,' but not in the tones of a tolling bell.… It can be uttered in the tones of one who is sticking with the patient or the victim and who will remain there to fight it out as long as possible."
The terminal patient commonly senses abandonment. From entering the hospital, she ceases being a sentient adult with a personality and becomes a number. Bodily functions of pulse and blood pressure and elimination become more important than a preference for strangers to call her "Mrs. Jones" rather than "Barbara" or "Honey." People are making decisions for her, and she may have little or no say in her own treatment.
H. Norman Wright lists in Crisis Counseling four ways abandonment occurs: Communicating in brief and formal monologues, in which those around the patient do nearly all the talking and never allow the person to express inner fears and hurts; treating the person as a nonperson by talking about him as if he weren't there; ignoring or rejecting times when the patient approaches the subject of death, or papering them over with vacuous statements like, "Oh, you don't want to think that"; and literal abandonment, in which people avoid the patient or narrow contacts to the perfunctory.
The great need is to free the terminally ill person to talk about his or her needs and fears, to express those things that shouldn't have to be borne alone. This is where a pastor, secure about the realities of life and death, can open a door for a lonely and sometimes isolated person.
Hospitalized Children
When injury or sickness befalls a child, emotions crank up a few more notches. About eighteen months ago our daughter showed signs of what might be leukemia. Twenty-four hours later, test results indicated our fears were unfounded, but those twenty-four hours were difficult. The crisis of gravely sick or injured children reaches the hearts of everyone involved.
While hospitalization of a child proves critical for the adults involved, it may not be as terrible for the child as we might believe. Children are amazingly resilient. R. Wayne Willis, chaplain at Kosair Children's Hospital in Louisville, writes in a chapter of When Children Suffer, edited by Andrew D. Lester: "Much recent research indicates that stressors early in a child's life, such as a hospitalization, are not predictive of long-term problems." He feels that how the child responds to stress is more important in determining effects, good or bad, than the mere occurrence of stress.
But children entertain misconceptions about what is going on. They are apt to see the illness as something to punish them for some real or imaginary wrongdoing. This way of looking at it is called the "contamination theory"; something enters from the outside to contaminate them. Older children are able to understand that sometimes bodies break down.
Children need help to place blame where it belongs. They often have to be persuaded to believe the medical problem isn't because they've been naughty. A pastor, equipped with the truth of the Word and the benevolent authority of one close to God, can often help a child set straight his misguided thinking.
Ministering to hospitalized kids takes an understanding of their world. Drawing on the school-aged child's need to gain mastery over the world around him, Willis seeks "to find ways to help that child leave the hospital feeling like a success and not a failure.… One way … is to invite the child to become your teacher, to teach you what it is like to be sick. I recommend to pastoral visitors that they assume the posture of a student when they visit and in some way convey to the child, 'You are the expert here. I have no idea what it is like to be where you are. Please teach me.'" That sets up the child to be the authority, and everyone likes to feel important, especially in a depersonalized setting.
Willis encourages hospitalized children to take periodic flights of fantasy in the role of hero. Telling them stories of Little Orphan Annie or Huck Finn or Princess Leia or the Karate Kid, he gives them models and challenges them to take on evil and beat it with good. Such tales play up the will to fight, to overcome.
Willis remembers what he wants to do in a child's hospital room with an acrostic he devised: N-ABLE — name, absolve, bless, lay on hands, and emote. Let's examine these five tasks of the visiting pastor.
Name means to use the child's preferred name, to never treat the child as just another case. Children grow used to being the tummy that hurts, the blood pressure that needs taking, the crying that must be stopped. They want to be Pete or Katherine — their preferred names, better even than Peter or Kathy — not "that hernia case" or "Jim and Debbie's child." Willis encourages speaking even to the comatose and using their names, for many times they can hear.
To absolve is to disentangle a child from irrational guilt and to release him or her from true guilt. Ask children why they are in the hospital, and they may reply, "I fell off my bicycle" or "Our house caught on fire." They see the cause-and-effect relationship of accidents. But children admitted for illness may say, "I don't know," and hold some vague notion that it's their fault. Willis asks questions such as, "Do you think you deserved this? Is God trying to get you?" Answers tell him if he needs to tell the child clearly that the illness is not a punishment.
In cases where the child was responsible for an accident, say from riding a bicycle in a reckless way, Willis will "hear a confession" and then say, "Because you have confessed your fault, God has completely forgiven you, and you must now forgive yourself."
Bless is the next step. In When Children Suffer, Willis tells of a boy in a burn unit who received a policeman's recently granted Medal of Valor because the officer told him he deserved it more than himself. That was a blessing, an affirmation that boosted the boy. Willis writes, "When a child is meeting the threat of hospitalization successfully, I may say, 'Justin, because of your bravery in the face of great danger, I now dub you David the Giant Killer. From this day forward, you shall be known throughout the land not as Justin Phillips but as David, slayer of giants' — a metaphor, of course, for besting the rigors of hospital life."
Lay on hands. Touch can be a touchy thing. Willis notes that he never met a kid who likes to be patted on the head. He advises entering the child's private space by invitation only.
However, touch is one way of establishing emotional contact. Willis tells of a boy left quadriplegic by a car accident: "Every time I see him, in pretense of brushing the hair away, I make a point to touch his forehead. That is the only contact his sense of touch has with the rest of humanity. His friends have told me he likes it. Some children will enjoy thumb wrestling. Some will let you hold their hand or will take your arm while on a walk. Some will 'give you five' at the end of your visit, older kids a 'high five.'" Pastors take whatever opportunity is granted to lay on hands.
Emote. "The hospital minister's 'territory' is morale, the spirit of the patient," Willis writes. A child is like an adult in at least one way: he needs to talk about his emotional response to all that's happening to and around him. Willis suggests asking feeling questions: Were you scared? Did that make you a little embarrassed? How did you feel when the doctor told you that? To set the atmosphere, Willis isn't afraid to tell stories that show he has been scared or done dumb things or gotten angry.
"Working around honest children has a way of reminding us that there is a little child in each of us that has been stilled through the years of acculturation," Willis observes, "and we may need to spend some time getting back in shape for pediatrics. That means exercising the right hemisphere of our brains, our childlike, creative, playful, imaginative, intuitive self."
To make a child a victor upon emerging from the hospital — that's the goal. Disease or injury may inflict grievous tolls, but the spirit of the child can conquer, especially if that child and his family have the supportive care of pastor and church. With that care, the crisis eventually fades, but the lessons learned — and the faith found — continue.
Quickscan MAJOR ILLNESSES AND INJURIES
Immediate concerns:
1.Allow the medical personnel to do their work unimpeded.
2.The shock of sudden illness or injury affects not only the patient but all those around him or her. If you can't get to the patient immediately, minister to the family.
3.Timing is important; get to the people as quickly as possible.
Keep in mind:
1.People with terminal diseases probably know it. Our failure to talk about it doesn't shelter them; it isolates them. Whether now or later, they need to talk about it.
2.The adjustment to a new (and often inferior) body image can be a great crisis for illness or injury victims.
3.People need to grieve their losses or approaching death. The five stages of grief — denial and isolation, anger, bargaining, depression, and acceptance — can be expected in both patient and loved ones. These are normal, acceptable, and even therapeutic.
4.Hospitalized children need opportunities to be victors over the oppressors of pain, loneliness, and fear, to be recognized for little victories and significant steps.
5.With children, although hospitalization is traumatizing, it often is no indicator of future emotional difficulties.
Things to do or say:
1.Provide emotional and social support for the hospitalized and their families. Transportation, meals, baby-sitting, companionship, help with bills — all are part of the crisis response of caring churches.
2.Help patients sort the probable results of their injury or illness from the irrational or overstated fears, and then help them decide how to cope with impairment.
3.Give patients human touch, control over their situation, someone to talk with about what they want to talk about, the sense of being important.
4.Offer realistic hope. Help build the will to live.
5.Listen to the person who is ready to talk about death. Help her put life and faith in order so that death becomes a natural transition to real life, not a dread doorway to terror.
Things not to do or say:
1.Do not normally withhold information from the patient. In extreme circumstances (for instance, a car accident where a family is killed except for a lone member fighting for life) it may be prudent to time the release of all the details, but normally people have the right and the need to know the facts.
2.Do not make light of the adjustments an injured person may have to make to a new body image.
3.Do not talk about a patient in his presence — even one in a coma — as if the person were not there.
4.Do not give patients a sense of abandonment. Let them know when they can expect to see you, and make every effort to visit regularly.
For further study:
Kennedy, Eugene. Crisis Counseling: The Essential Guide for Nonprofessional Counselors. New York: Continuum Publishing Company, 1981.
Kübler-Ross, Elisabeth. On Death and Dying. New York: Macmillan Publishing Company, Inc., 1969.
Lester, Andrew D. Pastoral Care with Children in Crisis. Philadelphia: Westminster/John Knox Press, 1985.
Lester, Andrew D., ed. When Children Suffer: A Sourcebook for Ministry with Children in Crisis. Philadelphia: Westminster/ John Knox Press, 1987.
Copyright © 1989 by Christianity Today
