Accompanying others to the boundary of life
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Some months ago, I accepted an invitation to write an article entitled Dying a hope-filled death for Luke’s Journal, a journal focusing on integrating Christian faith and work in healthcare. As I mulled over this topic, I sensed a disconnection between the subject and the journal’s readership. Let me explain.
Death is the ultimate act of differentiation, a journey that we must take physically, alone, as we decay and return to the dust from which we came. Our body will continue to disintegrate until only earthly elements remain. Death is a final frontier. On a palliative care team, a chaplain spends time accompanying patients as they process emotional, existential and spiritual aspects of a terminal illness, helping such people ponder their own mortality and the agency and choices that are still open to them as they move towards their own death.
In contrast to this closing down of death, hope is a window to the future and contains the possibility of even transcending death in some belief systems. In everyday usage, hope has many horizons; some are nearby, others lie far into the distance. We hope for safe travel, alleviation of pain, to see children grow up, health, to spend time with family and friends and at the far horizon – a life beyond death.
From a Christian perspective, this hope is expressed even as we die physically; we confidently live with a spiritual hope, believing that those who die in Christ are being inwardly renewed. For a follower of Christ, maturing towards death is the final step in our faith journey. Death will strip us of all that is corrupt – our decaying flesh, sin, evil, and the pain and suffering of a broken world – everything that stands between us and seeing God face to face.
“The ministry of the living is to accompany and guide the other to the boundary of life, pointing at the signposts that lead to the journey beyond.”
Yet, only the sufferer themselves can attend to the matters that will ensure a hope-filled death despite the genuinely emotional, existential and spiritual pain of a decaying and disintegrating mortal body. All others around the sufferer are constrained and held back by life. The ministry of the living is to accompany and guide the other to the boundary of life, pointing at the signposts that lead to the journey beyond.
So, what might a Christian chaplain say to Christian physicians – those accompanying others to the boundary of life, about “dying a hope-filled death”? In truth, we are limited by our finite mortality, and we have no power given to us to bring about a hope-filled death for another – this is a power that alone belongs to the God of the living and dead. But as followers of the risen Lord Jesus, we live hope-filled lives, full of salt and light of which Archbishop Cranmer noted, “a true faith cannot be kept secret, but when occasion is offered, it will break out, and show itself by good works.”
A Christian physician, like all Christians, lives life within a complex matrix attending to both the vertical and the horizontal. Our lives are contextualised by a love for God and a love that extends to all others – the widow, the orphan the foreigner, the alien, the sufferer and even our enemies. As a physician, you do not need to go looking for people to love. God brings all kinds of people who suffer and are afflicted to the hospitals and hospices where you work. One can be reasonably sure that care of your patients is a subset of the good works that God has prepared in advance for you to do.
Our Christian faith holds that each person is created by God and loved and known by God, and each bears the image of God. When we are truly present to a person, we afford them dignity. To be present, is to give the other our undivided attention for the time we are with them. In the words of St Ignatius, we are willing to take ‘a long loving look at the real’ – the real person and their actual situation.
What does it mean for a physician to really love a patient undergoing palliative care? In First Corinthians, St Paul tells us that:
“love is patient; love is kind. It does not envy; it does not boast; it is not proud. It does not dishonour others; it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres.”
(I Cor 13:4-7 NIVUK)
If we apply this Christian love to a physician’s role with a patient, we might discern that the physician is operating out of two intertwined roles; the first is that of the physician, the professional exercise of the medical art of palliative care, its possibilities and limits. Professionally, a hope-filled life offers holistic medical care that honours the sufferer. The sufferer’s life is dignified when medical care is truthfully aligned with God’s love reflected in best practices that avoid self-seeking ambition, annoyance, envy or pride, and the capacity to persevere through difficulties to protect the sufferer’s God-given humanity. Fortunately, palliative care is a team discipline, and we share the load as fully as possible within the multidisciplinary team offering palliative care according to the patient’s wishes.
The second role is that of a person, where we operate out of what Christians for centuries have called our soul, the seat of our personhood. When operating out of our soul we have both the freedom to be ourselves while respecting well-defined professional boundaries. If we accept this, we can see that there are professional and personal aspects of love. It is out of the personal element of love that hope flows. A hope-filled life has the potential to overflow with patience, kindness, trustworthiness, and grace.
Yet, we might wonder where this wellspring of hope resides.
“When you bring your living soul close to another soul, your love, kindness can be experienced. By this in our human souls, we imitate our Lord.”
Jesus offers a metaphor to help explain. He describes Himself as the vine and us as the branches of the vine (John 14). He implores us to remain in him as he remains in us. He flows to us as xylem and phloem, the vine’s lifeblood or Christ’s Holy Spirit, flows through us. As we remain in Christ the vine, the Holy Spirit produces good and hope-filled fruit in our lives. In Galatians, St Paul explains that the fruit of the Spirit in the lives of Christians is seen through the actions of love, joy, peace, forbearance, kindness, goodness, faithfulness, gentleness and self-control. (Gal 5:22 NIVUK)
There is a significant overlap between the list of love from Corinthians and the fruit of the Spirit. Both lists include ideas of self-discipline and restraint expressed in terms of patience, forbearance and perseverance, and self-control held together with other concepts of moving towards another expressed as kindness, gentleness, and protection, but perhaps most clearly embodied in kindness.
Between the physician and the sufferer, there is a mingling. That of the hope that flows out of the soul of a genuinely kind and loving person and the dignified care of frail bodies that leak and no longer work as they once did.
Theologian Kirk Patston speaks of our human frailty as leaky bodies. Kindness moves us towards the care that quietly, patiently, lovingly mops up leaky bodies. Bodies leak. Bodies may bleed, ooze, cry tears of joy or sorrow, urinate, defecate, vomit, and dribble. And with infirmity, we increasingly lose control of bodily functions. Kindness is a connection between two unmasked souls, the sufferer whose physical mask is disintegrating before them and the carer who chooses to emerge from behind their professional mask to care from out of their soul.
For each of us, our human soul is not separate from our leaky body. Our soul is embodied, and the body is ensouled. Souls communicate. They communicate deeply through silences, words, metaphors, images and groans, gestures and expressions. Created human souls are created to connect with the Creator. Our soul cares about meaning and belonging, hopes and fears, life and loss, suffering and love, it is out of our soul that we pray.
“When you bring your living soul close to another soul, your love, kindness can be experienced.”
When you bring your living soul close to another soul, your love, kindness can be experienced. By this in our human souls, we imitate our Lord. This intermingling of hope and bodily suffering resembles the ultimate intermingling of lovingkindness with the breaking of a body, and the spilling of blood, by our fully human and fully divine Jesus Christ on the cross.
In Christ, we live hope-filled lives. Our hopes for those in our care are expressed through prayer, in the love that extends dignity to all patients and the kindness we show to each person. When your voice is gentle, your breathing relaxed, your manner non-defensive, and your presence kind, you offer safety and engender trust. The other person may feel safe enough to allow their soul to connect with yours; you are accompanying them a little on the way of their journey, and they are accompanying you on the path of your journey – your souls, for a time, mingle.
Living hope-filled lives helps to fill those dying with hope.
Kate Bradford Kate Bradford is full-time Anglicare chaplain at Westmead Hospital, Western Sydney. Previously she served as a Paediatric chaplain, at Sydney Children’s Hospital Network, (2007 -2017). Kate has taught pastoral care and is currently completing an MTh thesis on the nature of Christian soul care within public institutions. Prior to chaplaincy, Kate, and her husband Steve, were cross-cultural mission partners in Tanzania, where they worked at a remote rural hospital and Bible college (1996 -2006).