Joe was sitting on the edge of his bed. An IV tube was stuck in his arm, but otherwise he looked like a fairly chipper six-year-old.
I was a new student chaplain on the general medical-surgical floor at Children’s Hospital. The children on this floor, in most cases, were not seriously or critically ill-which meant that they could be a bit more lively in talking with a chaplain, or a bit more up to ignoring her!
“Hi,” I said, “my name is Nina Herrmann and I’m the new chaplain on this floor. What’s your name?”
“Joe White.”
“Hi, Joe White. Do you know what a chaplain is?”
“No-do you give shots?” he asked, with the universal look of a child faced with a needle.
“No.” I smiled. “They won’t let me.”
“That’s good. Do you play games?”
“I can. But that’s not the main thing a chaplain does. Do you go to church at home?”
“Yeah, most of the time.”
“Do you know the person who stands up in the pulpit and preaches-the minister?”
“Yeah-are you one of those?”
“Yes. Only I work here at the hospital instead of at a church.”
“But you’re a real minister?”
“I sure am.”
His face immediately lighted up. “Good,” he said. “I have a question I want to ask you.”
“Okay,” I said, with the fleeting thought that I might be better off at the dentist.
“Is it true what they say about God?”
(Digression: I was a television reporter before becoming a minister, and one lesson I learned from a number of schooled politicians is this: When faced with a difficult question, answer with another question. That at least will give you some time to think, and at best will help you find out more precisely where the person is coming from.)
“What exactly do you mean, ‘what they say about God?’ “
“You know, like God is there, even though you can’t see him.”
Pretty good for a six-year-old, I thought. He’s already grasping some theology! “Yes, Joe, I believe God is there even though we can’t see him.”
Long pause. Big smile on face. “Good! Then I believe in Santa Claus, too!”
When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things (1 Cor. 13:11, KJV).
Other than the fact that it is a humorous story, the example of Joe shows that children are first children, whether well or ill, and that they reason differently from adults. I had put my expectations onto Joe, thinking that he would expect me to answer, theologically, a difficult religious question-and it did indeed turn out to be one packed with theology. But as I was grappling for all my University of Chicago Divinity School “book learning,” Joe was figuring out, very logically, that if God is truly there even though we can’t see him, then Santa Claus must truly be there, too, even though we can’t see him. And when one is six years old, that is very important.
Listening Time
One thing to keep in mind when visiting ill children is that they are, first and foremost, children. Parents will ask you questions which-at least at first-they will expect you to answer. Children will ask you questions which, given some help and listening time, they often will answer for you, frequently with amazing, innocent insight or delightfully logical reasoning.
A key phrase here is “listening time.” Many ministers think that they have to have something to say, some consoling message of Jesus and the lambs hidden in their breast pocket when they visit the ill child. But often they merely need the ability to listen.
In visiting a child who does not have a terminal illness or severe trauma, the minister can bring continuity between times that the child is in church and Sunday school, and can show that the love and caring of a church-the body of Christ-goes beyond the walls of the sanctuary.
If you know that a child is going to go to the hospital, a telephone call beforehand would be nice. Most children don’t get telephone calls from adults. To keep the call special, call the child and only the child. (Be sure, before you call, that he knows he is going to the hospital!) Tell him he’ll be missed for the Sunday or Sundays he’s gone, and that you’ll be saying a special prayer for him while he’s in the hospital. It’s not necessary to promise to come to see him at this time unless you’re especially close. (If you do promise, be sure to keep your promise, or let him know that you can’t, and why. Children remember promises very literally.) Also, tell him that you’ll look forward to seeing him back in Sunday school and church very soon. If you were in the hospital in your childhood, tell him so, without going into great detail. That way he’ll know that you “lived through it” and apparently are fine.
Many children look up to their ministers with a touch of awe. A brief telephone call will mean much and can add some “importance” to going to the hospital. Letting him know you’ll look forward to seeing him in church again soon will help take away some apprehensions of the unknown. (Most children going to the hospital for normal procedures-reassured of this by their parents and others-are not afraid of dying because they have known no one in their peer group who has died in the hospital. If they do have a peer who has died in the hospital, it’s important that parents be reminded to reassure the child that his hospital stay is not like his friend’s and that he doesn’t have anything like his friend had.)
An earlier brief telephone call can be made to the parents to let them know that Johnny and they are in your prayers; that you’ll keep in touch; and that if they feel like talking at any time, they can call you. (This last you should offer at your discretion, in line with your other commitments and with the needs of the family.)
If the child is having surgery and if you have a reasonably close relationship with the family, your appearance will be appreciated during the operation. This is a tense time, regardless of the nature of the surgery, and your presence and a prayer for God’s guidance of the surgeons, success of the surgery, strength and peace for the parents, and a quick recovery for the child will be welcome. Don’t stay long unless you can tell that your continued presence is important to the family. The appearance and prayer are what will count.
If the surgery is critical and the outcome not reasonably certain, you can say to the family as you leave, “I have to go now, but Johnny and you will be in my prayers and on my mind. May I ask the volunteer (or nurse) to call my office with a report when surgery is over?” This move lets the family know that you will be thinking of them and that you realize this is an uncertain and difficult time; without putting the burden of an immediate report on them, it gives you an automatic report to help you follow through quickly should anything go wrong. Most surgical waiting rooms are staffed with volunteers who will call when surgery is over. Be sure you remember to leave your name and number and the name of the patient.
If you don’t know the family well, a visit during surgery may only add to their discomfort, and could make them wonder if you know something they don’t. It may meet your needs to “pastor,” but it may not meet their needs. A phone call before and a visit afterward may be best.
Assuming that surgery goes routinely, one visit to the hospital is normally sufficient-again, depending on your relationship with the child and family. Most ministers think it’s grand if they can arrive when both parents are there with the child. Three with one blow! And it’s certainly easier to talk with the parents, especially when things have gone well! But we should remember that the child is the one who is hospitalized. He’s the ill parishioner. He deserves our attention, too.
It’s best not to visit the child when he’s still in a lot of pain. That’s “Mommie and Daddy” time. A card is nice-a colorful one that sits up. It doesn’t have to be religious.
Visit the child when much of his discomfort is gone, and at a time when his school friends won’t be there. Ask the child-not his parents-what’s been happening to him (his surgery or illness), and listen, sympathizing when appropriate. Shots aren’t fun! Let him show you his bruises or his scar. Ask him if he’s made any new friends in the hospital and who they are. Let him show you his gifts and flowers. Bring him a church bulletin from the Sundays he’s missed. Even if he can’t read it, it probably has a picture on it. If his name is in the bulletin, have it underlined.
Before you go, offer to say a prayer with him and Mommie and Daddy, if they’re there. It’s nice if everyone holds hands at this time. Don’t be afraid of seeming “uncool.” People expect and want ministers to pray. Even better, ask Johnny and Mommie and Daddy if they want to “help you pray,” or if they want to “pray, too.” Most people don’t think they should-or can-pray when the minister is there to pray. And some are afraid because they think they won’t know what to say as “well” as the minister. But if you can let them know that this is a nice thing and an OK thing, without pushing it, it can help them and you a lot-often especially in serious or terminal cases.
Surprisingly, Johnny may take to it more easily, and thereby encourage his parents to pray, too. I usually say, when adults are present, “Would you like to pray with me before I go?” If they nod “Yes,” I then say, “Why don’t you go first, Johnny?” (or Mommie or Daddy), and then I bow my head. It can catch some people by surprise; but more often than not they’ll pray aloud, and it will turn out to be an important thing for all concerned.
If I’m alone with the child, I’ll usually say, “Johnny, would you help me say a prayer now? Why don’t you talk to Jesus first?”
An important follow-up to the hospital visit is a call when Johnny gets home or a personal welcome when he returns to church, whether the welcome is from the pulpit, as can be done in smaller churches, or person to person.
If your church has a library, get some books written for children on children going to the hospital and having surgery, on children with physical disabilities, and children dying. Also get some books on these topics for adults. About Handicaps, by Sara Bonnett Stein (Walker, 1974), is written for parents and children to read together, with a column for each. Resources such as these can be helpful for parents and children alike.
Someone to Talk To
Watching a child die is a rotten thing. There is no answer for it. There is no real salve for the wound of it. And anyone who thinks there is hasn’t watched a child die. One of the best things a minister can do is to admit all of that, first to himself and then to his parishioners who are the parents of a dying child. It is, in my belief, the first and single most important step in their relationship throughout. The longer the minister tries to pretend that he has the answers, or that there are absolute answers now on earth, and the longer he pushes “strength” and “stoicism” and God as salve for the wound, the further he’ll be from the reality of the process.
Having said all that, I would add that it doesn’t mean that faith in God cannot help during the process of suffering. Faith in God does not make the pain less real or the horror less absolute. But it does give us someone to talk to who is always there: someone to talk to in hope, in fear, in loneliness, in frenzy, in despair, in anger; someone to have to not talk to; and someone to come home to again someday with a “peace which passeth all understanding” (Phil. 4:7).
For seven years I haven’t been able to shake her. And I doubt that I ever will. She was a little girl hungry for a love that went beyond earth, because she knew she was dying, though she never came right out and said it. I had the title of chaplain, so she found me. She came to chapel at Children’s Hospital, and I was preaching that Sunday. She adopted me to talk to.
Her name was Laura and she was nine years old and had leukemia. She was a loner-no brothers, no sisters. She had a mother and a mother’s boyfriend who visited and who cared, but who couldn’t really ever believe that Laura would die.
She had wisps of hair. Once, only once, did she show me a photo of her with long, thick, dark hair. “I cried too much when it fell out,” she explained. “I still cry when I look at the old pictures too long.” She put the photo away. “Will you come to see me when you can?” There was no demand, no schedule. She had been in hospitals too long. She knew the lingo. She would be brave enough to ask, but survivor enough to take what she got. She got me-more often than the textbooks tell you she should have. But, looking back, I wish it could have been even more.
We didn’t always talk. We didn’t always do something. We didn’t always have lights on. It wasn’t always visiting hours. It wasn’t often very long, except for the last two nights. Mostly, we just sat with each other, and sometimes I rubbed her sore legs and knees.
“What’s heaven like?”
“Why do you ask?”
“I have leukemia.”
“What do you think heaven’s like?”
“No pain. To have my hair long again. To be able to run again. To be pretty again . . .”
“That’s what heaven’s like. That and seeing God.”
“But that scares me.”
“Why?”
“Will he be mad at me? I haven’t always been as good as I could.”
“Are you sorry about that?”
“Yes.”
“You could tell God that, even now.”
“I did already. But I didn’t know if it was time, or if he heard.”
“He heard. And any time to talk to God is the right time.”
“Then he won’t be mad?”
“No, he won’t be mad. I don’t think he would have been mad, anyway; just disappointed. But he’ll be glad you talked it over with him. He’ll forget all about it even. He probably has already.”
“Really?”
“Really. So heaven can be just new long hair and no pain and running and being pretty again-though you’re pretty right now, even though I know you don’t believe me.” She shook her head. “So in heaven you’ll be pretty to you, too . . . if that’s still important to you when you get there.”
“It will be.”
I wanted to hold her and throw my arms around her and cry with her and tickle her and laugh with her, then and so many other times. But all of that would have hurt her horribly. So we talked and sat with each other.
In the end I rubbed her legs and gave her Kleenex while blood oozed out her nose and mouth, and sat in a nighttime room with her between shots of morphine that had stopped helping days earlier.
No salve. No answer.
Ministering with Continuity
How do you visit a dying child? With her permission. And more than once or twice or three times-from the beginning, not only at the end.
In Laura’s case, I was lucky. She found me. She wanted a minister to go through this with her, if possible. I was there, and she found me. She was close to her mother, and I didn’t replace her mother. Laura gave me my own place.
It isn’t always that easy in the beginning. But don’t underestimate your potential value in relationship with a dying child. It’s easy to do that because then it’s easier not to get involved with the child. I know. I’ve been that route, too.
It is important when visiting a dying child-just as in visiting an ill but not dying child-to visit the child. That doesn’t mean time should not be allowed for the parents, the siblings and the family together. But the child deserves her own minister, too.
It is a huge task to become truly involved as minister to a dying child and her family. But you are pastor of a congregation. If the child and family are known in your congregation, then many members will be concerned about their welfare, and a lot of them will want to do something but will be afraid or uncomfortable or unsure. You, as pastor, not only represent God (in your own fallible way!) in all of this, but on behalf of your congregation you can represent their caring to the child and her family. By ministering with continuity to the dying child and her family, you also are ministering to and on behalf of your congregation.
I met Laura reasonably early in her next-to-last hospital stay. I had a chance to know her while she still could race about the halls pretty well dragging her ever-present IV pole and bottles behind her with the arm to which their tubes were attached. Often she would be waiting for me by the elevator, to show me some picture or a toy. But it took time for Laura to build up trust enough to talk about God and heaven and leukemia and how she felt as a person. And time is what you need if you are to visit the dying child with her permission.
Try to visit the child each time she’s in the hospital-twice a week, at least. If she’s ill at home, telephone or stop by with some regularity (call ahead). Don’t stay long. It’s important with a child, or any patient with whom you are trying to build trust, to leave before she begins to realize that she wants you to leave. If a parent is always there, that’s OK in the beginning, especially if you don’t know the child well. But soon try to find a visiting time when the child’s parents aren’t there. A head nurse or social worker often can tell you this.
In situations of long-term hospitalization, the unit’s head nurse or charge nurse, social worker and hospital chaplain can be invaluable. Try to get to meet them (remember, they’re busy, too) and leave your name and number and ask that they contact you any time they have new or important information. (It’s best to have the family’s permission.) At the same time, knowing that you are interested and involved will mean much to the hospital staff.
When talking with the child, ask her to tell you what’s been happening to her and how she feels about it. Let her know that it’s OK to be scared or to cry-that it’s normal under the circumstances. Ask her about visitors and gifts and cards; about school and friends and pets. If she cries, that’s all right. Just sit quietly or hold her hand or hold her, depending on the level of trust built up. But be careful not to equate having the child cry in your arms or bare her soul to you with “success.” “Success” is ministering to the child where she is, along with occasionally opening doors that she has the option to go through.
In time, it can be helpful to find one thing that you can do together that can carry over from visit to visit. With one child I played a game of “War” each visit. With another I said nightly prayers. With another I played finger puppets. When a child sees you, if she can think of something happy related to your visit, she will look forward to your visit. Often, the more ill she becomes, the less actively or the less often you’ll do the things that got you “started.” But by then the trust, the relationship, will not need a prop.
Another thing that can be effective through the long process is a small stuffed animal or a doll. Don’t bring it on your first visit, but maybe on your seventh or eighth. Perhaps it will be an animal similar to one which appeared in a story you read together, though it doesn’t have to be.
Tell the child you thought of her and of your visits together when you saw the animal or doll, and you wanted her to have it. Name the toy. Then, as the child becomes worse, sometimes the animal can help you communicate feelings when the child is too depressed or frightened or ill to talk for herself.
“Hi, Mary. How are you today?”
Silence.
“I guess not too good.”
Silence.
“Fido, how do you think Mary is today?”
Silence.
“Hmmm, even Fido’s not talking. I wonder, if Fido felt like talking, how he’d say Mary’s feeling today?”
Mary: “Awful.”
“That’s too bad. Why would Fido say Mary is feeling awful?”
Mary: “Because I have to have another operation . . .”
Another helpful way of communicating is to draw pictures together. Often a quiet child will express her feelings in drawings. If you have trouble in this area, many children’s hospitals have recreation therapists or “child life therapists” who are very creative. Talk with one who knows the child you’re visiting and ask for ideas.
In visiting a dying child, give her some control. Don’t assume that she wants to see you every time, though that may be the case. Ask her.
If she can’t talk much or doesn’t want to talk much, you can bring some church news or tell her a funny story about yourself. But don’t do a lot of this. Just sitting with her and holding her hand, rubbing legs or joints that may hurt (ask before you do this), holding her in your lap and rocking, if possible-even older ill children respond to this-and saying a prayer with her can be enough, or even better than a lot of talking. Let the child guide you.
As I mentioned earlier, prayer is important. Don’t assume that it’s not desired or that there can be a “wrong” time to offer it. Rarely, if ever, is there a “wrong time” for offering prayer, even if it’s rejected.
I said earlier that faith in God gives us “someone to have to not talk to.” A child-or adult-who has been praying and suddenly doesn’t want to pray or who appears to be taking an obligatory, indifferent attitude to offered prayer, likely is angry with or hurt by God.
Children, when angry or hurt with their parents, often will stalk off and say, “I’m never going to speak to you again!” It’s the helpless child’s way of hitting back at the parent who appears to be in control within a situation the child doesn’t understand. The same can be true when “talking with God” suddenly becomes difficult.
If you encounter this reaction, it can be a clue to where the person is in her struggle with the dying situation, whether that person be parent or child.
The minister can be a steady, stable rock for a dying child (even if the minister isn’t feeling inside like a stable and steady rock, and even if the minister weeps occasionally with the child-or the parents). That doesn’t mean that the minister can or should or will replace a parent or sibling or friend. It does mean that a minister can be a visible reminder of God’s love and caring to a dying child and can have a special, ongoing place in the “process.”
It may be that the child never will open her soul to you. But again, that is not the only measure of “success.” Our goal as ministers in visiting the dying child can be quietly, steadily to say, by our presence, by our continuity, by our giving of personhood and caring to the child herself, “God is with you throughout this, and he cares about you and loves you. You are valuable each day to God.”
We may never say that in so many words; but we will say it if we make the commitment of presence-not merely at the end, like the vultures, but from the beginning.
“A little child shall lead them.” Ill and dying children will lead us through our visits with them if only we will let them.
Nina Herrmann Donnelley is a chaplain at the Rehabilitation Institute of Chicago.
Copyright © 1983 by the author or Christianity Today/Leadership Journal. Click here for reprint information on Leadership Journal.
