What can we say?

June 01, 2010

What can we say?

The aim of this article is to help Christians feel more comfortable visiting both Christian and non-Christian friends, relatives and neighbours, either at home or in hospital, who are facing serious illness. Often people would like to visit and offer some consolation from the gospel, but don’t know where to start. I also hope the article may assist Christian health professionals and clergy in their different roles.

The thought of visiting the seriously ill can leave us feeling awkward, unsure of what to do, and even feeling physically sick. What can we say? This not an easy topic and I have no instant formulas. Very few people feel comfortable initially visiting someone seriously ill (or the close relative of someone who is seriously ill). Such visiting does not come naturally to most of us, but is something that must be learnt.

I wish to share two particular instances where I tried to offer some pastoral care. In both cases, I was left knowing that I had totally missed the mark and feeling that I was hopelessly inadequate for the task.

In one instance I was young theological student visiting a patient in a nursing home. I came to the room of an elderly lady. She was so happy that she had a visitor. I remember her joy, and then the look of disappointment on her face as she registered that I obviously thought the only valuable conversations were ones about God. The visit had started so well; where had I gone wrong?

Around this time I had a Christian friend who was widowed in tragic circumstances. I felt compelled to write to her, and ‘share’ some biblical consolations genuinely believing that the Bible had a ‘word’ for every situation. Yet, when someone suggested that I actually visit her as she had very few visitors, I didn’t go. I couldn’t face her and didn’t know what I could possibly say.

As I reflected on these situations, it became clear that when our fumbling attempts go wrong, people can get hurt. They may also close the door to the gospel, and dishonour our heavenly Father. But this is not the end of the matter. We can humbly learn from our mistakes and learn once again to reach out in Christian love.

By separating out some of the issues that surround such a visit and exploring them individually, we begin to see that a visit can flow as a natural, if not easy, expression of our Christian love.

The first thing to keep in mind is that everybody needs God’s message of saving love in Jesus. Faith comes by hearing the word. There are two avenues we can explore to help this happen.[1]

It is necessary to have experienced this saving love ourselves before being able to share it. Then we internalise this saving love in a simple form that people can hear and see.

We can help people to hear by helping to remove obstacles that are preventing them from hearing.

We also need to be able to hear when people say ‘No.’

Helping people hear

We are in their space

When we visit a seriously ill person, either in their own home or a hospital ward, we are in their ‘space’. As guests, we need to show a heightened level of respect. This is obvious if you have gone into a home, but it is also helpful to keep in mind that as you sit by someone’s bed in a ward, you have effectively walked through their front door, passed the living room along the hall, and are in their bedroom. This is very different situation to talking to someone who has walked into your church, or you met on a railway platform.

It is often best to keep the visit short

Illness and ageing have physiological effects on people. They may be weak and tire easily. Serious illness or crisis can also leave people with a decreased ability to absorb new information and ideas, and feeling they have very little or no mental space, or ability to concentrate. Dementia may also be a factor in some cases. It can be difficult for the person to let you know this. Patients can be very polite or submissive as the whole experience can rob them of their usual confidence. Keep visits short in general. If they have enjoyed your visit they can always ask you to stay longer. You visit may also be interrupted by staff carrying out their various duties.

Spiritual health is not the same as mental or physical health.

Spiritual, mental and physical health are intimately related but they remain distinct. People may be quite mentally impaired, but their spirit may be well and alert. If you visit someone in a coma or having suffered some sort of brain damage, or on life support, assume they can hear you and also that their spirit is present. Greet them, talk to them, show you love and care for them.

Heightened sensitivity

People who are seriously ill, approaching death, in extreme grief or suffering dementia often have a heightened sensitivity to feelings, spiritual things and other people’s motives. There is a clarity on some things that is astounding even if they are unable to make a cup of tea. Some may also be very emotionally fragile.

For some people, music they had known when they were young can be a very effective way of connecting with patients with severe dementia. The role of hymns and Christian music or liturgy can be very significant as they can encapsulate ideas of faith that are unintelligible as words. Songs that work well in this sort of ministry are Amazing Grace, Jesus Loves Me, and The Lord’s My Shepherd (old version). Touch can also be very significant in these cases, often holding a hand may be appreciated, but be sensitive to the fact that some people may not be comfortable with having their hand held.

Need to give and receive love[2]

Visitors to a seriously ill person may be disarmed by the patient’s concern for others; they may be very worried about a present they need to buy for someone or some other matter that may seem unimportant in the scheme of things. The patient is expressing a need to do the things that show love and concern; they may be finishing off something they need to do before they die. My grandmother bought a present for her cleaning lady days before she was finally hospitalised. My sister found it on her dressing table after she had died. To be helpful in these matters may be greatly appreciated.

Need for meaning and hope[3]

Patients are often trying to make sense of life and reflect on key events and people in their life. Hope is also a basic need. People find hope in the short term: events such as weddings, anniversaries or expected babies provide a horizon beyond the present suffering. For believers, the long term hope of eternity is a great comfort, but even with this people may still fear the actual process of dying.

Man looking out window

Being a valuable visitor

Be prayerful

It is important to be active in prayer for the patient. Prayer reminds us we are not in this alone: we are not bringing God into the situation for he is already there. The patient is a person made in the image of God, for whom Christ died. Our role is to be present in our Lord’s service as we reflect Christ.

Be a comfortable Christian

When we visit someone in hospital, we visit as ourselves. Take small opportunities in your every day life to let people know you are a Christian. Your actions will be read through the lens of the knowledge that you are a Christian. If you seem natural in your faith, an offer to care or pray is unlikely to come across as an awkward situation.

Be filled with Jesus’ love

Our presence expresses Jesus’ love, so a visit will overflow with Jesus’ love. If we are running on empty we have nothing to give. This is not a heightened emotional state but genuine warmth that is other person centred. Love others as we ourselves have been loved.

Be humble

We need to be honest with ourselves: do we get a buzz from evangelism? If so, it is possible that we might trample right over someone else’s sensitive spirit and not even notice. Remember that the patient may be extremely perceptive and see through us and our motives like glass. Take no pride that the spirits bow to you but rather that your name is written in the book of life (Luke 10:17-20). The visit is not about us, it is about another person wholly special to God, a person whom God loves more than we are ever able to.

Be right with God

Before a visit, I try to clear my mind and prepare myself before God. I remind myself of his wonderful saving love for me on the cross, and confess any sins that are distracting me or making me edgy or cross. I sing something in my head, like Jesus Loves Me, or May the Mind of Christ. If I’ve had a stressful time getting to the visit I pray for peace and calmness. This is a process of focusing and consciously going in God’s strength. Remember things done in our own strength are worth nothing, we need Jesus’ help and his strength.

Be respectful

Be mindful of the possibility of a power relationship, particularly if you are a minister or a medical professional treating the patient. Within medical facilities there are strict professional boundaries. In Britain the General Medical Council code suggests that discussing religion can be part of the care provided to patients, as long as the individual’s wishes are respected. Proselytising is strictly warned against.[4] Within these guidelines it is acceptable to ask a patient if they are a member of a faith community, or to let a patient know you will be praying for them. Should the patient respond to such a comment and ask a question you could respond gently according to the hope within you.

Ministry professionals are used to giving advice or teaching people how they should think about God in a situation. Particular care should be taken because of the vulnerability of the patient. The power relationship could easily be perceived as abusive, should the patient be made upset or distressed by your visit. Listening to the patient empathically, as they talk about the things on their mind, allows them to guide the conversation. This is unlikely to cause offence as you are allowing the patient to be in control in a very out of control experience. Often the result of this is that barriers are broken down and you are welcomed into their life experiences.

The Visit

Connecting

Some people may be intuitively good at connecting with others but for most of us it is a learnt skill. Does the patient want a visit from us? In some situations it may be appropriate to phone ahead to see if a visit is convenient. Often you can tell whether the visit is welcome from various cues: body language (if mobile, do they move towards you or pull away); or whether or not they turn off the TV, put their phone away, or close their book.

Do we have the grace to withdraw when, after spending half an hour to find an expensive parking space, we find the visit is not convenient, or if we do not have a connection with the patient?

If we honestly feel invited, move closer, ask, ‘May I sit down’, if a chair is available (if not, perhaps get a chair from the corridor, as it’s better to be sitting and be at the same eye level as the patient). Be aware of your speech volume - is it too loud or too soft? A friend recently mentioned when she was in hospital recovering from surgery that everyone seemed to be shouting and she couldn’t cope with the noise. Other patients may be deaf or have hearing aids.

Conversation[5]

Conversation admits us into different facets of people’s lives.

The first level is social: small talk, chat about things of general interest or people or events in common. Open ended questions are often helpful here, such as ‘How are things?’ It is up to the patient how much they reveal.

The second level is emotional, where a person may reveal how they feel, how things are really going, how other things are affected by the illness or situation. They may disclose that they really do not feel up to much today, they may even express fear or anxiety. This is not the place to start with the gospel, but rather to reflect back their feelings: ‘It sounds like you are having a difficult time’ or something similar. By being interested in what they are interested in, you might be able to say some people find prayer helps when they are afraid, and such a comment may lead to the next level.

The third level is where things of a spiritual quality may be disclosed. This may include thoughts like ‘Where is God in this situation?’ ‘Why is this happening to me’, or questions about the meaning of the illness and what is going to happen later on. People may also express their thankfulness to God for his faithfulness or other such affirmations.

A fourth level may be reached if an offer of prayer is accepted or Bible reading or an opportunity to share some deep truth of Jesus.

As we spend time with people we need to be sensitive to the level they are admitting us to and graciously hear their ‘No’ when they don’t wish to continue a conversation or visit.

Listening in conversation

As we spend time with the patient listening to them, we show our genuine interest in them and their lives. When we reflect back to them something of what they are communicating we show we are trying to understand them and their world. We do this as we demonstrate that we hear their pain, disappointments, fears, anxieties, joys expectations and hopes. We should respond to them as they are, not as we think they should be, so we need to be in the present, as each day can be different, with its own worries and concerns.

Hearing about the lives of elderly people is a wonderful way to share their world. We can often catch a glimpse as to where God fits or conversely does not fit in their world. Was church part of their life at some stage? If so, we can ask if they drifted away or whether something happened to cause them to stop going. It is worth remembering that almost every adult will have thought about God some time in their life. These impressions of God may be very different to the biblical heavenly Father, but this is the picture of God they see when God is mentioned. The God that has been rejected may be a remote or ineffective God, a God who let little children suffer; he may be a harsh judge who likes to catch you out or doesn’t want you to be happy, or one who does not answer prayer.

Some underlying spiritual themes

Disappointment with God

Feeling let down by God or the church, especially if it is unexpressed, can constitute an effective block to talking about spiritual matters. Sometimes by just suggesting that someone might have wondered where God was in all this, and allowing them say how they feel is very liberating. After hearing them, we can say we are sad they felt so let down, and although it may seem that God is against them, he has not abandoned them but longs for them to call to him.

Why is this happening?

We all face tough questions. Why do mothers of young children die of cancer? Why do children die? Why do older people so full of health and vitality get sudden onset dementia? We might want to venture that we live in a fallen and broken world, but in reality this does not say anything about why any particular situation occurred rather than another. We don’t know. An answer to the ‘why’ doesn’t have the power to remove the pain, but if we are able to introduce a ‘who’ we can introduce Jesus who can walk with us through the pain. ‘How we can go on’ is a more helpful direction than ‘why’ which can be a destructive downward spiral.

Existing with pain and suffering

Living with pain and suffering has a logical link to the gospel: Christ too endured great suffering and cruelty. He understands our grief and pain, it does not go unnoticed. He does not abandon us even in our greatest pain for he longs for us to call out to him. We are made in the image of God and he is never indifferent to the suffering of his creatures: he sent his dear Son to die for them to bring them to himself.

Death

Even Christians can fear the actual process of dying, and wondering about the final journey that we must make alone. The dying can be encouraged to look to Jesus, to put their trust in him and receive his promise of never forsaking them even as they pass through death. Sometimes talking about the boundaries of life is a more gentle way to talk to someone facing death - it allows them to name death if they wish to.

Concern for loved ones

Recorded phone calls from people trapped in the twin towers of 9/11 show an overwhelming concern for family left behind. Messages of love and concern for children, partners, parents, family and friends give a rare insight into the immediate concerns of people facing death. We can offer a deep comfort by offering to help care for and pray for family who will be left behind.

Burdens too great to carry

To people feeling overwhelmed by burdens, Jesus’ invitation to all who are weary and heavy laden to come to him ( Matt 11:28-30) can be a great comfort. Many of David’s psalms, too, express feelings of being entirely overwhelmed, but the knowledge that God was there and able to save was a comfort for David (e.g. Ps 6, 31, 55).

Anxiety

People may express feelings of anxiety. Sharing something of the peace of God may help. We can explain that God is with us in our anxieties and gives us his peace even in the midst of trouble and storms, and that this happens when we ask Jesus for help and rely on him.

Regrets

Some people raise regrets. Let them talk, don’t cut them off with ‘it’s all right’ or ‘it doesn’t matter’ or ‘let’s not talk about that now’. Hear them out without interrupting. Acknowledge that they wish that they had done things differently, and allow them to discover whether they need to put things right with someone. Share that we all have done things wrong. Forgive them if they are apologising to you, but also ask them gently if they have made their peace with God. You could offer to help them with a simple prayer of confession and introduce them to Jesus.

Prayer and familiar touchstones

An offer to pray is often a natural overflowing of our concern for the patient. In addition to personal prayers, we could offer to pray aloud for them and their situation. These offers are very often accepted, but if someone does not wish us to pray, accept their preference graciously. If we do pray it is important not to use the prayer to preach, but rather present the patient and their situation before our loving Lord asking him to reach into the situation and draw them to himself and reveal his love for them. Many older people still remember the Lord’s Prayer, especially from the King James Version of the Bible. People with very little Christian background, may still have heard Psalm 23, or Amazing Grace, and these can be helpful touchstones.

Conclusion

The kinds of conversations we have been talking about are our fumbling attempts to introduce our friend Jesus to people in great need. We are trying to put their hand in his in the tentative beginnings of a new friendship.

God is calling his people home to himself, and he graciously allows us to be involved in this. We offer the saving love of Jesus to all we meet hoping they will choose to accept it. There are no formulas, but as we listen to people and accompany them through their grief, we trust God to lead us in our prayers, thoughts, actions and words.

[1] Personal conversation with Jackie Stoneman, Director of Studies Mary Andrews College, 2010.

[2] M. Highfield & C. Cason, ‘Spiritual needs of patients: are they recognised?’ Cancer Nursing, Vol. 6, 1983, pp187-192.

[3] Ibid.

[4] General Medical Council, Supplementary Guidance, Personal Beliefs and Medical Practice,

http://www.gmc-uk.org/guidance/ethical_guidance/personal_beliefs.asp; Nick Triggle (Health reporter), ‘Doctors want the right to talk faith’, BBC News, 2009.

[5] Charles Topper, Spirituality in Pastoral Counseling and the Community Helping Professions (New York: The Haworth Press, 2003).