Caregiving Trifecta

By Tracy L. Tucker

What might spiritual care in the face of death look like from an Open and Relational perspective?

“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, a sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen.”

Elisabeth Kübler-Ross

None of us has or will escape the experience of death, what lives ultimately dies. Psychiatrist, Irvin Yalom refers to our awareness and the associated fears of death as the “Mortal Wound.” We carry that wound with us from our earliest day to our final one.

Like a piece of a societal jigsaw puzzle, difficult feelings of grief, loss, longing, feeling lost, and even dread of death have become embedded components of most, if not all cultures. Some will find ways of locating hope and even finding peace in the face of death. The romantic embrace of death as an escape or something to be desired over a more difficult life can mask some of the pain, but it is in our nature to struggle with facing death, especially first-hand.

The spiritual care provider will likely observe this struggle in their patients, patients’ families, and even within themselves, often challenging everything they previously believed. Robert Dykstra was transparent as he wrote of his earlier experience in hospital chaplaincy, “The theological language I had relied on in ‘safer’ moments in my ministry seemed to grow increasingly flat and unable to sustain me in what I was witnessing in these overwhelming moments of ministry.”

Consider this encounter from my role as hospice chaplain which challenged my personal beliefs and theological language. George (name changed) was in his mid-50s and very committed to his Hindu faith. George’s husband, Frank (name changed) was slightly older and did not share George’s faith. Frank would tell you that he, in fact, has no religious faith other than that he believes there must be some kind of god or supreme deity somewhere.

George had a painful form of cancer that was attacking his bones and had metastasized throughout his abdomen. Frank spent his day at George’s bedside, knowing that the time for George’s final transition was only hours away. George had not taken in any food or water for several days and had not spoken for the past two days.

During the last couple hours of George’s life, Frank walked out of the room on the hospice unit and declared: “If or when I ever come face to face with God, he will have some serious explaining to do.”

How does the spiritual care provider respond? How does our theory of God inform the type and level of care we offer to people in the face of death or the dying? What are the barriers to our own ability to provide spiritual care? What principles, theories, practices or theology might we employ as we provide excellent care in end-of-life crises?

How do we help hurting, angry people negotiate their pain and very natural feelings tied to their loss and grief so that they might become one of Kübler-Ross’ “beautiful people”? I propose three practices for spiritual care providers to employ in the face of death: empathy, presence and relationship.

Empathy

Yalom wrote: “Empathy is the most powerful tool we have in our efforts to connect with other people. It is the glue of human connectedness and permits us to feel, at a deep level, what someone else is feeling.” An authentic and meaningful spiritual care approach will be one of persistent empathy.

Educated through a conservative evangelical system and serving several decades in churches of that same ilk, my own first approach to spiritual care assumed a conservative Christian worldview. However, people in need of spiritual care are not necessarily sympathetic to that worldview. Within today’s culture, that understanding of God, faith, and life is often thought of as dated, if not irrelevant.

Pastor, psychologist and founder of Stephen Ministries Saint Louis, Kenneth Haugk defines the role of the spiritual caregiver in the life of their care recipient. “When you enter another person’s home, you know there are rules or customs of tradition, courtesy, and common sense. You are the guest. The other person is the host, and the host sets the rules, not you.”

Consider the above example of George and Frank. George, a devout Hindu likely welcomed death, anticipating that he will have advanced even closer toward mokṣa. Frank’s grief was compounded by George’s spiritual conviction. Frank wanted George to fight for every last breath and to have that final moment as a shared experience with George.

Empathy necessitates the spiritual care provider share in Frank’s desire for that fading moment with George. There is no room for commentary or judgment about selfishness, sexual orientation, debate about the existence of God, or how we should approach God respectfully. The spiritual care provider is the guest, not the host in this relationship. The host sets the agenda. And the agenda is empathy.

Author and sociologist Brené Brown wrote that “Empathy, the most powerful tool of compassion, is an emotional skill set that allows us to understand what someone is experiencing and to reflect back that understanding.”

Presence

In the Old Testament story of Job there are four friends who respond to Job’s claim to be a hapless victim of his personal tragic circumstances. My take on this story as it’s written is that the fourth of the friends, Elihu simply sat with Job and waited while the other friends berate Job for his stubborn insistence upon his own righteousness. Reading this story I always wish that Elihu had simply remained at Job’s side and kept his “helpful input” to himself.

Job was trying to make sense of his loss. Who among us would not have serious questions if our possessions and means of survival had been taken as well as our children and their families? Elihu had the opportunity to be simply present with Job and share in his pain. But instead, he opened his mouth to speak.

Being present with a person in pain and sharing in that pain, grief, loneliness, fear, whatever journey they are on, signals that their feelings are valid and offers the potential that they just might find a sense of well-being. This might be true even for those who may be transitioning from this life. Of all the items on Job’s list of “Things I Need,” critics and advisors were certainly not there.

Standing in the hospice unit that day, my presence with Frank gave space for him to have a shared experience in a relationship that could endure the differences in theology, ideology, lifestyle, and anger that represented his authentic feelings.

Relationship

Spiritual care is, if nothing else, relational. In his essay entitled, “Crossing the Ocean of Suffering, A Medical Perspective on Divine Impassability,” Dr. Jonathan Kopel wrote about a relational God of the Bible who modeled a relationship with humanity in pain. Rather than a God out of Bette Midler lyrics where God is watching us from a distance, Kapel suggests that God is actually affected by our circumstances and present with us in them. “For God shows himself to be courageous and willing to be vulnerable by experiencing life with us. God opens himself to our pains and joins us on our journey. We do not feel alone or abandoned by God.”

The authentic and effective spiritual care provider will embrace one in need through relational language and methodology. The spiritual care provider will be vulnerable, transparent enough to be relatable, and available enough to feel the pain of the other. Kopel adds, “Rather than a private affair, suffering [I would add ‘grieving’] becomes a participation between our soul and God.”

Frank was only part of my life for a few days, but that time allowed a relationship to form that provided for conversation and, I believe, effective care. Because my theory of God streams from an open and relational grounding, it made sense to choose a non-coercive and empathetic approach to both George’s and Frank’s needs.

In the conclusion to his work entitled The Varieties of Religious Experience, William James penned this statement, “Who knows whether the faithfulness of individuals here below to their own poor over-beliefs may not actually help God, in turn, to be more effectively faithful to his own greater tasks.”

Applying the practices of empathy, presence, and relationship reveals a lived experience with God as I understand God to be at work within an open and relational context. We are co-participants with God in this life, co-creators in a relational dynamic that which empowers us to become the hands of God, touching others at their point of pain and grief. This belief and praxis align us with a loving and compassionate approach to spiritual care within the context of death and the dying.

Tracy L. Tucker is a Senior Chaplain for Community Hospice and Palliative Care in Jacksonville Florida. He earned his MDiv from Nazarene Theological Seminary and is currently working on his DTM through Northwind Theological Seminary. Tracy is a Board Certified Chaplain through APC and has a Certification in Thanatology through ADEC. He enjoys a private cup of coffee most mornings while watching the hummingbirds at his patio feeder.

To purchase the book from which this essay comes, see Love Does Not Control: Therapists, Psychologists, and Counselors Explore Uncontrolling Love