Lessons From a Hospice Chaplain

A pastor friend of mine took a position as a hospice chaplain six months ago.  Recently, he wrote six lessons God has taught him in those first six months.

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Here are six things I am learning about the spiritual and physiological aspects of death and dying:
1) Say it while you still can.
Some of our patients are not yet on their “death beds,” but others are. Rarely have I seen such people live out their final days as the movies portray. Most people in this situation are quite motionless and less verbal than I imagined. Their words (for those who can still speak) are . . . few . . . and . . . far . . . between, and thoughts are often incomplete and interrupted by brief periods of sleep.
Although it is possible to hear some final words from a patient before he/she takes a last breath, normality seems to be disconnected words, from a body reserving most of its energy for the few vital organs still working. This may last a few hours, a few days, or a few months.
Fortunately, it seems that such people can understand what others are saying, even when sedated.
2) The skilled nursing home option is an a-moral, not immoral choice.
Before chaplaincy, I found it easy to assume that most nursing facilities were bad and that most families who send their loved ones to such places were worse. Boy was I wrong!
Providing home care for the dying is like raising a 90+ pound infant. It is a dirty, isolated and monotonous job that may breed exhaustion, depression and false guilt. Some have nicknamed it the “36 hour workday.”
Through the chaplaincy, the Lord is teaching me empathy for such people. He is also teaching me to evaluate a nursing facility by its personnel, not its decor. My favorite facility is an old building with an administrator and staff who treat their patients like family and grieve deeply when their patients decline and die.
Dying people need capable caregivers. Sometimes such people are blood relatives, and other times they are paid caregivers, who treat their patients with respect and compassion. Those in skilled nursing facilities are trained to deal with a broad host of issues, while also having 12-16 hours daily to rest. Home caregivers learn as they go, and are always on the clock. Loved ones must ask themselves which type of caregiver is better for the patient, and for themselves.
3) Desperation alone will not soften a hard heart.
Those who are staring death in the face are more receptive to the gospel, right? Not always.
There’s a story in the New Testament about two men facing imminent death. One mocked faith in Christ, while the other repented and believed. These men were not on their death-beds; they were on crosses.
Many people avoid death-related topics while they are healthy, presuming that they’ll ponder such things on their death-beds, but to believe that desperation will change the heart is a false and dangerous assumption.
Although I’m only six months in, I have observed a common trend: dying people tend to meditate most on what was important to them before their decline. If Jesus Christ and an eternity with him was far from their minds when they had a clean bill of health, the death-bed alone won’t change that.
I rejoice that I have had several opportunities to share the gospel with patients, but I’ve also seen people on the edge of death, who have no desire to ponder what awaits them on the other side. Then at their funerals, their families talk about what their loved ones are doing in Heaven, even though such people had no interest in discussing Heaven.
Now, one might assume that I’m a pushy proselytizer, but quite the contrary. Hospice is not the Church, and hospice chaplains are to respect the rights of their patients to believe differently than they. So in such situations, I usually ask a non-threatening question like, “Do you think much about what’s on the other side?” Sometimes the answer is, “no,” especially for those who never attended church.
Jesus said in John 3:5-8: “Truly, truly, I say to you, unless one is born of water and the Spirit, he cannot enter the kingdom of God. That which is born of the flesh is flesh, and that which is born of the Spirit is spirit. Do not marvel that I said to you, ‘You must be born again.’ The wind blows where it wishes, and you hear its sound, but you do not know where it comes from or where it goes. So it is with everyone who is born of the Spirit.”
Sometimes the Spirit “blows” across my chaplaincy conversations, and sometimes He does not.
And so I pray not just for desperation, but also for Spiritual intervention.
4) Dysfunction is par for the course.
One of the benefits of hospice chaplaincy is getting to know families, and one of the most comforting things to discover is that my family is not the only imperfect one.
The more I get to know families, the more I discover different degrees of tragedy and/or conflict within. Weeping with the weeping and helping families seek peacemaking is a big part of the chaplain’s task.
5) They forget my name, but not the Liturgy.
Several of my patients suffer from dementia or Alzheimer’s, and most of them forget who I am between visits. If they were churched, however, they have keen recollections of hymns and Scripture.
So I do a lot of singing and Scripture-reading to people who can barely utter a sentence, but who will never forget, “Amazing Grace,” Christmas Hymns, The Lord’s Prayer, or Psalm 23. It really is astounding to see how worship repetitions cling to people’s minds, when so many other things have disappeared.
I used to preach that meaningful repetition was an important part of Christian worship. Now I see one reason why.
6) I can still do the verb, though am no Longer the noun.
My good friends often ask me if I miss pastoring and preaching.
I do, but not as much as I would have thought. I miss the people, and I do miss the preaching, but hospice chaplaincy gives me some unique opportunities to shepherd people, many of whom have become disconnected from their churches because of their condition.
Preaching one hour a week was a great privilege, but so is many hours a week showing love and compassion to dying people and their loved ones.
Although I miss the pulpit, I rejoice that Christ is producing in me a heart to come alongside people and love them in a unique way, without the administrative and responsibility pressures (Heb. 13:17) one finds in pastoring a church.