DEATH IS NOT THE END: REFLECTIONS ON HOSPITAL CHAPLAINCY

Victorian deathbed scene. Courtesy of the British Library.

https://www.youtube.com/watch?v=c8PYpUa5bg4

Composer: Twinkie Clark
Leader: Dr. Mattie Moss Clark
Singer: Bettye Ransom Nelson

[Refrain]
   All is well
   Because in Christ I dwell
   (Because of Christ)

[Verse]
   Lord, I’ve been ‘buked
   And I’ve been scorned,
   I’ve been worn
   Lord, I’ve been torn (so many times)
   But I dwell in Jesus (not in these things)
   In these things I have peace with the Lord

I wrote an earlier draft of this reflection as part of my final unit of Clinical Pastoral Education (CPE), in July of this past year.  A rite of passage for many seminarians, CPE typically starts during seminary as a single summer-long internship in the hospital setting, where ministers-in-training can explore their pastoral vocation with patients, families and staff of many different backgrounds, not just Episcopal or Christian.  In addition to “clinical time” on the hospital floors, a large chunk of the curriculum consists of theological reflection with other chaplains, also of various faith orientations, who are undergoing the same training.

For me, as for many, CPE was my first experience doing pastoral ministry, and immediately after seminary I took the plunge into doing six more units of CPE.  This was my “chaplain residency” training that lasted two years.  After chaplain residency (of either one or two years), a newly-minted, full-fledged hospital chaplain will typically seek board certification and denominational endorsement.  (Ask me around this time next year how that’s going…)

As a hospital chaplain, I’m responsible for providing spiritual and emotional support to patients, families and staff in the medical center where I work.  While this often includes prayer and faith-based interventions, just as often I must be a pastoral presence to people who do not identify with any faith, or with a faith that’s different from my own.  And yet at all times I must be aware of how my personal faith informs my work of being present to people in what may be their darkest hour of need.  Hence, this reflection:

The medieval English author, Julian of Norwich, once wrote: “It [was necessary] that there should be sin; but all shall be well, and all shall be well, and all manner of thing shall be well.” This is one of my favorite quotes. I often use its second half with patients.

But what does it mean for “all manner of thing to be well” when everything is falling apart? How can we say “all is well” when people’s lives are being destroyed?

It’s actually rare for me to bring up the Christian faith with others, even patients, until things get really bad. And usually, that’s death. In those moments, which usually happen when I’m on call, I serve only one purpose for my Christian patients and families: to remind them of our “faith [which] is the substance of things hoped for, the evidence of things not seen” (Hebrews 11:1, KJV) -- a way that most of us are not hard-wired to hope.

Upon my graduation from seminary, my internship parish gave me a copy of the “Green Book” – Ministry with the Sick.  It’s a compilation of liturgies, prayers and Bible passages that are needed in the clinical setting, everything from “Communion under Special Circumstances” to “Termination of Life-Sustaining Treatment.”  It’s an Episcopal book, but relevant to all Christians regardless of denominations.  With the help of this resource, I’m able to express this supernatural Christian hope of life after death with families at the bedside:

Almighty God, look on this your servant, lying in great weakness, and comfort [them] with the promise of everlasting life, given in the resurrection of your Son Jesus Christ our Lord. (p. 86)

I’m not the author of this hope. I’m simply an instrument, reminding people who have (mostly) forgotten the Church’s promise that they are of eternal significance to God’s heart – not a number, a statistic, or a consumer of expert medical care which, at the end of the day, only does so much. But to many clinicians, death really is the end of the road.  It means defeat.

The first time I ever brought up the promise of Christian faith -- in a family meeting during my first chaplain residency -- I was extremely nervous. I thought it might not be welcome.  Maybe it would sound delusional. Through an interpreter, I told the husband of a dying patient – we’ll call her “Valentina,” -- that I was so enjoying getting to know her.

Valentina and I belonged to different denominations, that’s for sure. She was evangelical with charismatic flair, and inhabited a starkly different social location than me. Every time I visited Valentina with my barely-intermediate Spanish, she would graciously tell me she was getting “better” (“mejor”), which of course was not true. She was getting worse and worse. But she would always be listening to sermons. One time, the preacher was going on a rant about the evils of “lesbianism and homosexuality.” As a gay Episcopalian, I was very amused.  Valentina turned down the volume, right as it was getting really juicy.

But in this family meeting, there were no sermons, only a stark truth: Valentina was dying. Her condition had declined to the point where she was no longer able to make decisions for herself or understand what was going on, so she was not present in the meeting.  After several doctors were done spelling out the reality of her impending demise to her husband, it was my turn to offer her husband, and the rest of the team, a reminder of how important Valentina’s Christian faith was to her.  I followed this with a risky pronouncement: “Death… is not the end for your wife.”

Risky because certainly, death, as the cessation of biological function, may seem like the end, for the dying and for their loved ones.  The clinical setting, which may not readily acknowledge faith in anything beyond that cessation, can thus reinforce the finality of death without meaning to.  And yet when science ends, so to speak, and there are no more curative medical interventions available, our devastation is still true, and was undeniable in this meeting with Valentina’s husband.  There is still meaning embedded in this liminal space between the known and the unknown, revealed to us in the form of grief and love.

And this is where chaplains offer something unique within the medical system.  Drawing on the professed or even implicit faith of our patients and their families, in the midst of grief, loss, and final professions of love, we help give voice to the inalienable value of every human being, which from my faith-based standpoint is fundamentally a spiritual reality.  My patient’s infinite worth is an icon of God’s eternal care for that person, a care epitomized by the resurrection of God’s son Jesus Christ – a resurrection which Christians ultimately hope to participate in.

I’ll often say a prayer for patients of many religious persuasions that goes something like this: “God, I’m praying today on behalf of your servant N for total healing of body, mind, and spirit.” Sometimes, I will add, “if it be your will.” This is always good to pray for, and I believe miraculous healing sometimes happens. But usually not.

I have a Pentecostal patient, “Winston,” whom I’ve seen at least a dozen times. He’s gotten to the point where, although still praying for “his miracle” – total healing – he has come to accept, all by himself, that he must hold his hope for healing alongside the reality that, in his words, “cancer kills.” And now, we can talk about the promise of faith, a promise which is true regardless of what kind of healing will be possible for Winston on this side of death.

Because, at the end of the day, Jesus did not come in order to give me my best life now. He did not do his ministry in order to show me that, if I believe hard enough, he will shower me with favor -- and that without such steadfast belief, any death on my part is... well, just my own fault, isn't it?

We might be tempted to say the same of Jesus's death. It doesn’t appear he prayed hard enough, either. Remember that on the cross, his prayers remained unanswered as he died the death of a common criminal.

The promise of Christian faith is not that everything will be okay.  In fact, we see that too often, the opposite happens. Now, perhaps, it’s never been clearer that we have no power to save ourselves, even as we scramble to pretend like we know what we’re doing as a society. Perhaps it is only through death that we will be preserved.

And yet, Jesus teaches me that despite death – his, mine and everyone’s – all is well. In his resurrection, Jesus says: “Behold, I am making all things new” (Revelation 21:5, ESV).

As the Green Book – well, actually, the Bible – says:

Who will separate us from the love of Christ? Will hardship, or distress, or persecution, or famine, or nakedness, or peril, or sword? […] For I am convinced that neither death, nor life, nor angels, nor rulers, nor things present, nor things to come, nor powers, nor height, nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord. (Romans 35, 38-39; NRSV)