A woman I’ll call Marylynn, the fifty-nine-year-old mother of one of my parishioners, was dying of cancer. When I first entered her living room, now converted into a “dying room” complete with hospital bed and institutional sheets, death haunted the house.
Her husband had silently pointed my way into the room, whispering at the door, “I won’t disturb the two of you.” He then beat a hasty retreat to his garage. The shades were pulled tightly across the window, permitting only a few streams of dust-flecked light to trickle to the bed. The stale smell of stagnant air and unwatered flowers hung over the room like mist over a pond.
Marylynn, thin and pale, was lying limp in her bed. Her breathing was shallow. Death, the doctor had said, would come soon.
I went to her side, took her hand, and announced myself. Still I was not sure she had recognized who I was or even that I had come into the room. I said I’d like to pray with her. In prayer I called upon the Holy Spirit for trust in the resurrection and assurance of eternal life.
When I finished, Marylynn sat up. She looked directly into my eyes and said, “Damn it! Just because I’m dying doesn’t mean I want to hear about heaven!” She collapsed back into her bed like a balloon suddenly deflating.
Over the course of that visit, Marylynn informed me that if God was so mean as to strike her down with cancer just as she had started going back to church, she wasn’t sure she wanted to spend eternity with him. She hated God; she hated me; she hated her husband and her family.
Marylynn had begun my education about what she needed so she could die in faith.
I had approached Marylynn from my perspective. Seeing the signs of death in her environment and observing her husband’s avoidance, I had sensed she needed to talk. I was prepared to talk about the different psychological needs accompanying death, but I had limited her theological needs to only one. I had arrived with the preconceived notion that dying people needed to be comforted concerning heaven and hell, that Marylynn needed to be reminded death was not the end. I had been wrong.
What I did not know then, but know now, is that grief occurs in both psychological and theological stages. People face death asking many questions about God and the meaning of life. The truth of eternal life is only one question people ask as they approach their act of dying, and it is often not their most important issue. We need to be prepared to answer a variety of questions concerning the many stages of a person’s faith journey.
Jesus knew that. He used different perspectives and theological approaches, depending on the audience. With crowds and new converts, Jesus spoke in parables; however, he taught his disciples the meanings of the parables. Jesus adjusted his theological content in accordance with the needs and limitations of those around him.
I have learned that each of the stages of grief, described by Elisabeth Kbler-Ross and Granger Westberg, raises corresponding theological questions. I developed the following chart for a hospice workshop. (See below.)
Denial: Rejection of Evidence
When people hear they soon will die, an avalanche of new thoughts, information, questions, and demands for decisions rushes down on them. It’s overwhelming-too much to handle all at once. For their own protection, they need to avoid the immediate impact of the avalanche.
Frequently the first reaction to the news is to reject the evidence. By saying It can’t be true-it must be something else, they can step back, catch their breath, and get firmer footing before facing the news.
This protection through isolation lasts only as long as they can keep death at arm’s length. Therefore, while pushing away the evidence of an early death, they also push away the idea they will die at all. The finality of life, however, can only be put off for a limited time. Eventually the truth begins to overtake them: God does permit people to die.
People tend to run faster and faster to keep away from the news; they need help in slowing down. When they do, they can sort through the crush of new information a little at a time. Instead of being crushed by too many things at once, they can dig their way out at their own pace.
Our job at this initial stage is to help them focus on one aspect of that avalanche at a time. We need to let them examine it for a while. We stay with them while they slowly turn it over and over in their minds and then help them put it in its proper place in their understanding of life.
For the time being, questions or statements that lead them to focus on their own beliefs about life and death help more than statements about our beliefs. They do not need the additional load of our new ideas, ways of thinking, or theologies. The time will come to state our understanding and our perspectives on death.
Most recently I relearned this lesson from Diane. She went to her physician because of a slight difficulty catching her breath, expecting the doctor to give her the same tranquilizer and advice he had usually given for this recurring problem. This time, however, he admitted her to the hospital, ran three days of tests, and concluded she had terminal cancer of the lymph system.
Shortly after this diagnosis I visited Diane. Her words came in quick, staccato sentences, jumping from one subject to the next: “I’ve got to get out of here. I’ve got to get the house cleaned up. My husband doesn’t know how to cook. Oh, did I tell you about my niece’s wedding next year? I called the doctor and told him I wanted a second opinion. I wonder if I can still travel? In a couple of days I’ll be fit as a fiddle. I’m just a little tired right now.”
I held her hand. “There seem to be too many things for you to do,” I said.
Diane squeezed my hand as if she wanted to crush it. A tear ran down the side of her nose and dropped into her lap. The silence in the room seemed to last forever. “The doctor said I’m going to die,” she told me, speaking as if she were telling me about getting her hair cut, “but I’m not ready.”
“Let’s pray that God gives you time to do things,” I answered.
Diane could not think about the pain, the change in her lifestyle, the physical side effects of chemotherapy, or the procedures the physician wanted to try. She did not want to discuss her feelings about death, being hospitalized, or slowly deteriorating in strength. She needed permission to still live for a while, to take care of her husband as she had throughout their marriage, to get things ready in the brief time she had left. She needed to dig out from the avalanche.
Denial: Rejection of Help
Once people start to accept the fact of imminent death, another dilemma emerges. They are now thrown for a loss concerning what to trust. By an unwelcome turn of events, they have been forced to give up the unconscious fantasy we all harbor-that life will go on forever. Everything they had counted on and hoped for now seems to be challenged and discarded. If those dreams are not true, what is?
Christians start asking the same question: Can I count on anything I used to believe in? People need grounding at this point. It is still too early to start adding new ideas from our perspectives. Our job is to help them place what is happening on the foundation of their own faith laid in previous years. This helps people reassure themselves that all has not changed; what has changed is their awareness of death.
I watched a man pretty much do that by himself.
Ed, in his early eighties, was dying of old age and the many complications the body encounters when it starts to wear out all at once. “I’ve known for years I’d die someday,” he once told me, “but now that it’s so close, I’m afraid. I thought it would be different. Maybe I don’t really believe anymore.”
Ed slumped over the table at the edge of his bed. He was partially shaven and had a small portion of his recent lunch stuck to the corner of his mouth. He was wearing a faded bathrobe, an overly large hospital gown, and the paper slippers provided him by the hospital. His thin, varicose-veined legs sticking out beneath the robe completed the picture of a frail human being barely capable of caring for himself.
I asked if he ever believed. With a touch of surprise, he said, “Of course! I grew up in the church. My parents were churchgoers since they were born, too. We Swedes have always believed!” He raised up and threw his shoulders back, like a proud fisherman about to show his catch.
Ed spent the next half hour telling me about his history of faith. We never spoke much that day about dying, but Ed taught me a lot about what it takes to live for eighty years and still keep the faith. I believe he taught himself, too.
Denial: Rejection of Others
Denial takes yet another form: people deny that anyone else can possibly appreciate what they are experiencing. While probably true in terms of fully knowing their inner thoughts and fears, the position also closes out our attempts to empathize or show support. At this point we need to demonstrate we appreciate them, even if we cannot fully understand the specifics of what they are feeling.
A nonmember taught me this in a graphic way. Esther was a brittle diabetic in her late sixties. The disease was slowly taking its toll through kidney failure, loss of sight, and gangrene in an infected foot. By the time we were introduced, she had undergone the amputation of first her toes and then her foot. The problem persisted in crawling ever higher up her leg.
One day, when I was bringing her communion, she could not stop crying. I put my hand on hers, trying to comfort her, and said, “Go ahead and cry. I know how you feel.”
Her crying stopped, but not from my comfort. She looked at me, her head tilted slightly to the side, and spoke like a mother to a child: “No you don’t. You have both legs, you can see, and you’re not dying. You don’t know what I am feeling. How could you?”
I was stunned. In trying to comfort her, I had unintentionally made light of her feelings by implying they were normal or common. In truth, they were special to her situation.
I told her I was wrong; she was right. I have felt fear. I have occasionally felt helpless and overwhelmed. I have felt like crying. But I was only guessing about her emotions. More important, I told her I cared, and I would continue to visit if she wanted to take the time to teach me how she was actually feeling.
She didn’t answer right away but kept looking at me as if she were sizing me up. Finally she smiled and said, “Maybe you know a little bit how I feel.”
People do not stop with rejecting other people; they also reject God. Frequently people will ask, “How can God, who never was afraid, really understand my fear?” Now they need additional information.
Only after they have permitted themselves to trust that we are trying to understand them-that we do not want to force our feelings on them-can we share effectively the truth of Scripture about the humanity of Jesus. Without denying the pain and specific reality of their grief, we need to communicate that Jesus went through pain and grief concerning his own death. The writings in Hebrews, Paul’s letters about his own struggles, and the prophets’ inner fears help people know they share good company in feeling overwhelmed by life-and-death issues. Not only does this show respect for people’s perspective, but these truths from Scripture also show that God does not quickly dismiss their feelings.
People do not need, especially at this time, the trite explanations that seem to roll so easily off the tongues of those trying to make dying a simple matter. A statement like “It’s all for the best in God’s plan for creation” most likely confirms people’s worst fear: God is playing around with their life without taking their feelings into account.
Emotional Release: Anger
Eventually the realization of what is happening sinks in. Now, instead of being snowed by external information, people feel like exploding. All the complexity of feelings that must be faced in approaching one’s own death bubble up inside, and they need to get them out.
Anger is typically one of the first emotions to expose itself. People get angry at the doctor for not being able to do something to stop whatever is happening; they get angry with their spouse for not pushing them toward medical action sooner; they get angry with us for our simplistic beliefs.
They also get angry with God. Usually they will ask, “If God really loves me, why doesn’t he do something?”
Anger is a natural way for people to express self-concern, and it provides the energy and desire for people to take care of themselves. That energy will be needed in the stages to come. They need permission to express all their feelings, so each one can be addressed in the open. After all, life does not seem fair; you and I don’t always like what is going on either.
People do not need our defensiveness about God. A simple listening ear and gentle probing into the depth of their anger is better than all our theological explanations about the wisdom and will of God. God can surely take care of himself without our help during this one stage in their journey with grief.
Emotional Release: Guilt and Bargaining
Guilt and bargaining seem to be two sides of the same coin. Both assume that what people have done, or will do, can affect the eventuality of death. Both arise from the proposition that we human beings have final control over life.
Typically people ask, “What did I do to deserve this?” or “What can I do to change this?” The later question usually takes the form of trying to bribe God: “I’ll become a minister of the gospel, give up drinking and smoking, and start tithing if only God will take this problem away.” People want to make up for some inner deficiency they assume caused their vulnerability to death.
People need to know God relates to them out of grace and not retaliation and vengeance. Sometimes they carry around leftover guilt from the past that frightens or shames them when they think about meeting God. Communion, prayer, scriptural passages, and the assurance of God’s forgiveness are most appropriate at this point.
A case in point concerns Franklin. Franklin was suffering from slow deterioration of his spinal column due to a malignancy that could be retarded but not stopped. He had led an active, physical life, earning his living in steel mills and construction. After the onset of his disease, all he could do was sit, and that for progressively shorter periods of time.
He was an avid follower of the radio ministries, well versed in the Bible, and a man of faith, yet his question to me was “What am I doing wrong?” He thought he was not praying hard enough. He felt he had not made up for old sins and had to do something so God would quit afflicting him with his back pain and would cure his cancer.
I could not relieve him of his pain or his dying; I could, however, offer relief for his guilt. We discussed forgiveness and scriptural references to “turning back to God’s constant welcome” and we celebrated communion. Franklin still had questions, but God’s promise to forgive helped him look forward in grace and not backward in fear.
Dying people are burdened with almost intolerable circumstances. They need hope and encouragement. What they do not need is more guilt by our suggesting they should have more faith in facing their ailment. A statement like “If you’d just put your faith in God, you would be able to accept this in peace” causes more stress than it eliminates.
Franklin’s wife was listening to the two of us talk one day, and I noticed her crying. She explained to me, “Maybe I should quit praying for his healing. I thought faith was only trusting that God would heal if we believe enough, not that we should trust him even in our sickness. Maybe I don’t have much faith after all.” By supporting Franklin’s ability to die well as a witness to faith, I had inadvertently closed off the possibility of his living well and being healed. I had emphasized how his faith was not leading Franklin to healing but to witnessing.
Simple truths about death or healing have built-in complications and are, in actuality, only partially correct. Since we do not know entirely the grace of God, we do not understand entirely his will to permit diseases and the process of dying. We need to admit our human limitations.
Although the dying are merely trying to make sense of their circumstances, we do them no favor if we suggest easy cause-and-effect answers to their current problem. When we exhibit our own continuing faith in the midst of things even we cannot explain and over which we have no control, it helps people later accept our presence and our care, if the will of God lets them continue to move toward death.
Lethargy/Depression: Reactive
Once the concept of dying begins to sink into people’s awareness, their approach to the future changes. They begin to visualize a world without their presence.
Often this leads to a basic form of insecurity: Does anybody care if I live or die? Questions about being missed or about the value of life are often asked. People need reassurance they are so important God sent his only Son to save them, that God has the hairs on their heads numbered. They need to explore how the world will be different without their presence. If it is true, we can help by saying, “I’ll miss you.”
Since they are just beginning to piece together how their death will fit into the scheme of history, now is not the time to preach the omnipotence of God, or that he can create new believers from the very stones.
However, our response to depression is not as easy to frame as it may seem, because depression has two sides: reactive and preparatory.
I typically note people’s words as pointers to what they are facing. If they are focused outward, it indicates preparatory depression. If their words point inward toward themselves, reactive depression is often the accompanying feeling. People may point to themselves as insignificant, or they may overcompensate by saying they are the only ones who can cope. Either way, they are still pointing to their need to have worth as their lives are ending.
One patient displayed both sides of depression during a single visit. Bill had only been hospitalized a short time, but during that time his body turned from a healthy, pain-free friend to a stranger increasing his suffering with every breath. He lay in bed, his wife holding his hand and his brothers standing off in the corner. They had been by his side for twenty-four hours straight.
I had been asked to visit because his pastor was out of town and did not know of Bill’s condition. After the usual awkward introductions, Bill told me he was dying, and because of his continually weakening condition, he was not going to be able to go back to work. He grieved that he wouldn’t even be able to finish his garden at home. We spoke about his fears and regrets.
At one point I asked if we could pray together. He replied, “No, ’cause I don’t want you to ask God for me to get better. I don’t feel like going on. Life’s not worth living.”
“Your wife will miss you,” I said. “God gave her to you.”
He turned to look at her. She was openly weeping. He pulled her hand over to both of his and asked, “Could we both pray with you?”
After the prayer Bill stared at the ceiling, and a lengthy silence filled the room. Eventually he rolled his head to the side. Our eyes met.
“What are you thinking?” I asked.
“About my grandchildren,” he whispered. “I was wondering who would take care of them.”
The finger of Bill’s words now pointed toward the world.
Lethargy/Depression: Preparatory
This other side of depression is the awareness that, in dying, they are leaving others behind, that their loved ones may not be well prepared, that this death will cause pain and problems. On this side, people need exactly the opposite reassurance than was required for reactive depression.
Now they need to be reminded that God is in control of the universe and that he will be able to take care of the family. People’s importance and meaning in life need to be separated from the ability of the world to go on without them.
A discussion about how they were instruments in God’s preparing their family for the future is one way to help them let the future rest in God’s hands. Specific plans for the future, such as insurance and funeral arrangements, are appropriate at this point.
Hope and Acceptance
Eventually, after many side trips and much exploring, people reach the point in their journey through grief where they can accept what is happening. They have been allowed to acknowledge that death is not fair, to rule out trying to scheme their way out of it, to learn that the love of God remains even for sinners, and to accept that the family will be taken care of in their absence. Finally they ask, “What’s next?”
Now I talk about Easter, the images of heaven prophesied in the Bible, and the promises of Jesus for life everlasting. Theologically they have reached the stage of receptivity to the beauty of eternal life.
Mary was eighty years old. Everyone was hanging on to her life and saying they did not want her to die. She told me she missed her husband who had died years before. Looking at her children, all with their own spouses, she said, “I’m tired. I just want to go home.”
Death is not so bad when you are ready for it in faith.
Linwood H. Chamberlain, Jr. is pastor of First Evangelical Lutheran Church in Lorain, Ohio.
SITTING WITH THE DYING
In over forty years as a pastor, Kenneth Nelson sat by the hospital bed of hundreds of dying Christians. Now in retirement, he reviews his modus operandi.
If there’s no response to word or touch, I don’t demand recognition. If from another world she calls me by a different name or asks about dead friends, I don’t correct her. I share bits of news-something I saw, a mutual friend I visited. When relatives come, I step into the background; families need time alone with their dying.
I neither catechize nor preach. If she nods her head when I suggest prayer, I offer one; if not, I pray silently. There’s nothing about which I need remind God. His dying child is coming home.
If regret is expressed for words and acts, I listen without interruption, then assure her that God heard the confession and forgave. If regret is spoken for having done so little with life, I assure my friend that God understands. And I confess that none of us will ever do all we could before death. I would like to make the passage from here to eternity as joyous as possible. My judgment in word or attitude is inappropriate.
If the person is in a coma, I try to imagine the joys and apprehensions of this friend, who is now approaching the Heavenly City.
If there’s no response during my visit, before leaving, I put my hand on my friend and offer a silent prayer.
If a person has neither friends nor relatives, I stay longer. Everyone deserves companionship in death.
– Kenneth E. Nelson
Prescott Valley, Arizona
Copyright © 1986 by the author or Christianity Today/Leadership Journal. Click here for reprint information on Leadership Journal.
