What hurting patients need is someone who will honestly listen to them, understand their feelings, and not hasten to change the subject.
—Richard Exley
My introduction to local church ministry, nearly twenty-five years ago, was a baptism by fire, or perhaps I should say, by sickness. A number of people in the church were hospitalized, and I went to visit, to encourage, to pray. But I felt horribly out of place.
This was a world of science and medicine. What good could I possibly do? Of what value were Scripture and prayer compared to surgery, therapies, and miracle drugs? I was intimidated. Still, I faithfully visited the sick and sat with their families during those critical hours in surgery when things could go either way.
I did what I thought was expected of me—administered Scripture and prayer. Not knowing what else to do, I simply tried to be there. I listened without saying much, mostly because I didn’t feel I had a lot worth saying.
Then I began receiving thank-you notes. “It meant so much to have you there when I was facing surgery.” “I can’t tell you how much strength I gained from your visit.”
I couldn’t believe it. The little I did had helped?
About two years later, I learned firsthand the dynamics of pastoral care.
Nine days after our daughter was born, my wife, Brenda, hemorrhaged. I rushed her to the hospital. By the time we arrived, she was nearly unconscious from loss of blood.
Immediately she was whisked away to surgery, and after I signed the consent forms, I was left alone with my fears. A host of terrifying possibilities set upon me. I paced the floor in agitation.
Then my mother arrived. She didn’t say anything, at least nothing I can remember, but I felt better just knowing she was there. Somehow I was strengthened, comforted, and encouraged by her presence.
The surgery was successful, and my wife recovered. But I have never forgotten the ministry I received from my mother’s presence that day.
Since then I’ve become highly sensitive to what makes for a welcome presence and what types of pastoral presence are definitely unwelcome.
World of the Sick
I find it helpful to remind myself what seriously sick people are experiencing.
First, there’s the pain, constant and unrelenting, as persistent as gravity, blotting out all else, until their world is reduced to the size of their sterile room.
Then there’s the weakness, the inability to control their body, which no longer functions on command. It, too, becomes an enemy, undermining their morale, even their faith.
On a psychological level, the sick experience a loss of power. Their familiar environment is gone. Now they live in a hospital, where they have little or no control over their lives. Before, they set much of their schedule. They decided when to get up and when to go to bed; what to eat, how to prepare it, and when to eat it.
Suddenly all of that’s changed. They may receive the finest medical care possible, but they’re no longer free to come and go. They’re told when to sleep, when to wake up, when to shower, and on occasion, they must even relieve themselves on command. They’re subjected to humiliating procedures, stripped of all modesty, poked and prodded and experimented with, all in the name of medicine. Eventually the medical vandalism may produce healing, but initially it can be demoralizing.
Finally, there’s the fear. Fear of the unknown. What’s going to happen to me? Will I get well? Will I be able to provide for my family, care for my children? Will I still have a job when I get well? Will insurance cover the hospital bills? Do I have enough sick leave?
Interlaced with these concerns is the ever-present possibility that they may not recover, which only creates more questions. Am I going to die? What will become of my family if something happens to me? Who will look after the children?
Faced with such naked need, I, as a minister, may fall prey to my unrealistic expectations. Although I know that I cannot work miracles, I still feel somehow diminished when there seems to be so little that I can do. Not infrequently, I am tempted to revert to platitudes, false assurances, or a premature prayer in a misguided attempt to provide comfort.
Premature Prayer
One lady, a victim of cancer, told me that when her pastor came to the hospital to see her, he would breeze in and out of her room, chatting all the time, hardly giving her a chance to get a word in edgewise. He did ask how she was doing. But she didn’t feel encouraged to respond honestly. After a few short minutes, he would pray and then leave.
She quickly tired of his insensitivity, and being an assertive person, she determined he was going to hear her out. When he arrived for his next visit, she was ready. He breezed in with his usual chatter and hurried questions: “How are you feeling today? Did you sleep well? Are you having much pain?”
When he paused, she unloaded, not angrily, just honestly.
“My pain is absolutely intolerable,” she said, looking him straight in the eye. “I’m afraid I’m dying. I pray day and night, but it seems that God has forsaken me. He never answers me, never makes his presence known.”
By now her pastor was visibly uncomfortable, and when she paused for a breath, he said, “Let’s pray.”
Before she had meekly followed his lead, but not today.
“Don’t do that to me,” she said. “You’re always using prayer like some kind of escape hatch. Every time I start to tell you what it’s like being barely thirty, the mother of two, and dying with cancer, you want to pray.
“But your prayer isn’t real. It’s just religious words, a smoke screen, so you can make a quick exit. Today you’re going to hear me out; you’re going to walk with me through my valley of the shadow of death. That’s what you’re supposed to do, you know. That’s why you’re here—so I don’t have to face death alone!”
He stayed until she finished, but it was a long time before he visited again.
Premature prayer can effectively isolate a sick person. The seriously ill have taught me the importance of timing and sensitivity.
One grieving father, following his son’s untimely death, said, “I know all the ‘right biblical passages.’ While the words of the Bible are true, grief renders them unreal.”
The same can be said about prayer. Nothing is more powerful than prayer; yet prayer can come across as unreal, too, if it doesn’t reflect the seriousness of the suffering. Prayer is appropriate in the sickroom, of course. But prayer should usually follow a time of listening deeply, and with compassion, to the sick and their families.
This is hard for those of us who are used to getting things done. It’s hard to sit and wait, to watch—powerless—as disease does its dirty work. We want to do something, anything. We are often gripped with an almost irresistible urge to exert our authority, to regain control of our world.
When we can’t bring a quick solution to the situation, our discomfort tempts us to flee the situation, at least emotionally. Or else we respond the wrong way. Patients frequently say things like “I don’t have much to look forward to anymore” or perhaps even “I think I’m going to die soon.”
We may respond by changing the subject, or with false assurances: “Don’t talk like that. You’re going to live for years. Why, you’ll probably outlive me!”
While our intent may be to bring cheer, it seldom works. Instead, such a response effectively isolates the patient. It invalidates the fear, leaving him or her to face sickness and suffering alone. What patients need in that moment is someone who will honestly listen to them, understand their feelings, and not hasten to change the subject.
This Present Comfort
Not long ago, I received a telephone call from a young woman named Diane, telling me that her three-year-old daughter was in intensive care. For eleven days she had maintained her bedside vigil, and when she finally called, she was nearly frantic. I comforted her as best I could and promised to come to the hospital as soon as I finished my appointments.
By the time I arrived, her daughter, Carrie, had been moved from intensive care. Her condition was still serious, but the prognosis was positive.
Now that her daughter was out of immediate danger, Diane tentatively voiced another concern. It involved her husband, Dave. He hadn’t been to the hospital for three days and was barely civil when he called.
The trouble had begun four nights earlier. He had insisted that she leave Carrie alone at the hospital and spend the night at home with him. “You’re going to get sick if you don’t get some rest,” he repeated.
Reluctantly she had agreed. Once they were in bed, his “real” motive became obvious. When she resisted his advances, a terrible argument ensued, and she returned to the hospital in tears.
“What kind of a man would do something like that?” Diane demanded.
I breathed a prayer for wisdom before I ventured an answer. “Although Dave’s behavior seems extreme, it’s not that unusual. In times of stress, men often seek intimacy with their wives, especially if they have a healthy marriage.”
“But how can he even think of sex at a time like this? I mean, Carrie is in the hospital—practically at death’s door—and I’m totally exhausted. Making love is the farthest thing from my mind.”
“His behavior was insensitive, I’ll grant you, but he’s probably not as unfeeling as you think. He’s hurting, too, and undoubtedly afraid to face the possibility of Carrie’s death. Making love with you may have been his way of coping.”
Before she could respond, Dave walked in. Ignoring me, he said, “I’m sorry, Diane. I’ve been acting like a fool.”
Illness of any kind produces stress, especially a critical illness. No member of a family is immune, and research indicates that many marriages fail under the pressure. In addition to the obvious difficulties of maintaining a normal homelife, there are also enormous psychological pressures, which men and women often react to in decidedly different ways, creating additional tension and misunderstanding.
The overriding feeling is often a sense of helplessness. A beloved spouse or child is suffering, perhaps even facing death, and no one can do anything about it. Men often respond in one or two ways: anger or escape.
An assertive man, who is used to taking charge and getting things done, will grow angry because of his inability to rectify the situation. He may take his feelings out on the doctors and other health professionals, accusing them of incompetence or worse. Or he may direct his anger toward his own family.
His rage is really directed toward the disease that threatens his loved one or toward God who has “allowed” this to happen or even toward his own helplessness.
Other men try to escape. They lose themselves in their work or in household chores. Frequently they deny the seriousness of the situation, refusing to face the possibility of impending death. This, in effect, isolates them from both their family and the patient. The resulting loneliness and resentment further strains the already over-stressed family.
A woman, on the other hand, tends to invest herself totally in the sick person, especially if the patient is her child. For her there is no world outside of that small hospital room, no concern except the welfare of her suffering child. When other concerns press upon her, she thinks, Others will have to understand. This is an emergency. Nothing else matters. The resulting jealousies and tensions add to the family trauma.
I understood these things, at least in theory, but could I help Dave and Diane come to grips with them?
I suggested to Dave and Diane that we go to the hospital cafeteria for coffee. Once we had our cups and were seated, I leaned toward Dave and asked, “Been pretty rough, has it?”
For a long time, he didn’t say anything, just stared at the steam rising from his coffee. Finally he took a deep breath and said, “I feel so helpless. The two people I love most in all the world are hurting, and I can’t do anything. It feels like I’m losing them both.”
“Can you tell me about it?”
“When Carrie got sick, I was scared. Real scared. But I put on a brave front for Diane. Then it seemed she shut me out, too.”
“What do you mean?” I asked.
“She was, you know, so preoccupied with Carrie. She would hardly leave her bedside, even to eat. It was like no one else existed, not me, not anyone.”
I nodded, and he continued, “I care about Carrie, too, but life goes on. I still have to get up, go to work, and make a living. For Diane, none of that matters. When I try to tell her how I feel, she just clams up, or else she accuses me of not caring about Carrie.”
Many couples coping with a serious illness face similar tensions. By being there, I try to feel their hurt and anger and help them understand each other.
I suggested to Diane that Dave is not an unfeeling brute in desiring sexual intimacy; it’s his way of trying to connect with his wife at this time.
And I told Dave, “Diane does not have an abnormal fixation. She is simply responding as mothers have always responded. Her child is deathly ill, and all her maternal instincts demand that she be near her. The fact that she can do nothing but maintain her bedside vigil does not, in any way, diminish her sense of responsibility. She does not explain her feelings, doesn’t even imagine that she should. In her way of thinking, you must surely feel the same way. After all, Carrie is your child, too.”
Once a couple accepts the legitimacy of each other’s feelings, they can better understand what is happening to them. Such understanding enables them to face the common enemy of illness united, rather than mistakenly attacking each other.
Although, in the case of Dave and Diane, explanation was part of the ministry I provided, the real power was my presence. They were able to hear my explanations because I first was willing to share their pain.
The Presence in My Presence
A few weeks ago, a young wife in our congregation learned she had a malignant tumor. It was, of course, disconcerting news, though the doctor’s prognosis was quite positive. On the morning of the scheduled surgery, my wife, Brenda, and I drove to the hospital, arriving just as the woman and her husband were getting out of their car. We accompanied them as she was admitted to the hospital and prepared for surgery.
It was a tense time. Jerry, her husband, was quietly attentive to her, not daring to miss a single moment of this precious time. She was brave, glad the waiting was almost over, eager to get the whole thing behind them.
Brenda and I listened as they made small talk about their boys. Just that morning, the car had rolled out of the garage and was at that moment straddling the mailbox in front of their house, awaiting the tow truck.
After a while the room grew still, each of us silently entertaining our thoughts. Finally, I shared some Scripture, and we all prayed. Soon the attendants came for her, and she was wheeled away to surgery.
Just yesterday we received a note from her. To Brenda she wrote, “Thank you for loving, caring, crying.… It meant so much to see you before my surgery. Your presence, prayers, and concern made a difficult time bearable.”
To me she wrote, “Jerry and I were touched and loved when you and Brenda came to the hospital the morning of my surgery. I think it was neat of God to send you there early enough to escort us from the parking lot. We drew on your strength just having you there.”
Years ago I might have puzzled over her card. Not anymore. I still don’t fully understand how my presence helps, but I know it does. Even when it seems we aren’t doing much, when it seems that the best we can manage are silent tears, a quick hug, and a shared prayer, God makes it enough.
Copyright © 1997
