She's Got a Ticket

One of the most eye opening books I have read regarding Hospice issues, is "Final Gifts" written by two hospice nurses, Maggie Callanan and Patricia Kelley. It speaks of the language of the dying, and relates their experiences as hospice nurses, identifying the needs that each patient had in order to completely let go. Without having the years of experience, and paying attention to the different signs, we would all miss out on the messages that our loved ones are trying to share with us, and thus, we miss out on the sacred experiences that are being acted out in front of us.

Recently, I had a patient who was in her 90's. "Elizabeth" was originally from Chicago area, but had lived in Southern California with her family for years. Her sister was still living in the Chicago area, being taken care of by her son. Both Elizabeth and her sister were in the last stages of their lives. One morning, Elizabeth related to her daughter that she needed to go get her sister, in order to go ice skating, but she needed to get the ticket to go. Her daughter thought little about that comment until she spoke with her cousin, and relayed that story to him. He told Elizabeth's daughter that his mother had said the same thing, just days before, except that she needed to go get her sister Elizabeth. Both were communicating the need to go on a trip, needing the other one, and needing a ticket to go.


Only a few weeks later, as Elizabeth began her transitioning phase, her daughter went and got some tickets. She placed them in her mom's hand and said, "Mom, you have your tickets now, it's ok for you to go." Elizabeth passed away just minutes later. To my knowledge, her sister is still waiting to go on her trip. My hope for her is that she will have her ticket in her hands soon.



I have personally witnessed many times in my time as a hospice spiritual care counselor, is our patients who call out the names of those in their family who have gone before them. Although no one else in the room may see them, the dying person certainly does. I have experienced it in my own family as well. It gives me great comfort to know, that even though our loved ones are leaving us, that they are often met and escorted by their spouses, siblings, parents, grandparents, or others of significance. It doesn't seem as lonely a journey to die, knowing they are held on this side of life as well as the next.

20th Year Anniversary

It dawned on me today that I have been ordained for 20 years today, in the PCUSA. Although this is a Thursday and I was ordained on a Sunday afternoon. But it makes me stop and think about the last 20 years, and to realize not only everywhere I have been, but spiritually how I have changed in that time, as I have grown in understanding of the One who called me, and of myself; who I am called to be.

20 years of ministry have been hard. But they have also given me experiences that I wouldn't trade for anything. I have had many moments of what I would call "Holy Ground." Those are moments that are beyond our ability to control circumstances; when God has moved within me and within the hearts of those I was called to serve, and we come away feeling we had a deeper understanding of who we are to be, or how we are to respond to situations in life, and of who God is.

I would say that as I have grown older, and hopefully wiser, I have felt a greater sense of compassion within, and a greater comfort level with mystery. For as many questions that I have had answered, I have developed 10 more questions, and it doesn't mean that I feel less assured, or secure in faith. It means that I can entrust myself to God, and don't necessarily need to have all the answers. God has been released from the box and is bigger than ever, and yet still tangible and ever present. What is the saying? "I may not know what the future holds, but I know Who holds the future." It is wonderful to be able to let go and be.

What I do know is spiritual care, pastoral care, is my PASSION. I love it, I am called to it, and I have an energy to learn more, to explore more, to show compassion more, to help accompany others on their spiritual journeys, as it deals with life and death. Hospice has been a rich place for me; that paradoxical place of dealing with death and dying and grief, but learning and appreciating the preciousness of life. I will never say never about returning to parish ministry, but for now, I am where I am supposed to be.

So today, I am grateful for the spiritual mentors that have accompanied me along the way, who have contributed to the pastor that I am today, who have taught me a tremendous amount and loved me even through my major blunders! I am grateful to my family who have supported me not just with words but with their actions. I am grateful for the gifts that I have received along the way, in the most unexpected places, and often through the painful experiences of life. And I am grateful for the fact that the process of becoming is still happening, and hopefully will never die.

I am grateful for Jesus Christ, who has given me life and hope and modeled for me a life of love, mercy and compassion.

Susan

The Right to Know of a Terminal Condition

This morning I went by a patient’s home for an initial Spiritual Assessment. I called the patient ahead of time, and she was fine with my coming over. However, when I arrived, I was met at the entry hall by the patient’s daughter and told that I needed to speak to her aunt first. After a short conversation about the role of Spiritual Care Counselor, it became apparent that the patient’s family has not told her that she is dying. It isn’t the first time I have run into this situation, and it certainly won’t be the last, but it disturbs me, every time I run across it.

There are reasons why people withhold information: Fear, Denial, fear, Cultural, fear, etc. I have seen the same scenario, where it is just a matter of time when they do feel the need to share the truth with the patient. With support, education, and encouragement, they do bring the truth into the open, and in those times they have often discovered that the reality was not as scary as their imaginations were. But the end result of continuing to keep it a secret could be a damaged relationship with the one who they were trying to protect, but who now feels betrayed since everyone in the family knew except for them. Can you imagine learning that everyone else not only knew but were making important decisions about your care without consulting you?
But actually, in most cases, the patient does know, if for no other reason than their family members are behaving differently, and are more secretive. But, they know that they feel different, weaker, etc. It becomes the proverbial gray elephant in the room that no one wants to talk about.

But there is a statement entitled : “The Dying Person’s Bill of Rights.” It was developed at a workshop on “The Terminally Ill Patient and the Helping Person,” sponsored by the Southwestern Michigan Insurance Education Council and conducted by Amelia J. Barbus.

· “ I have the right to be treated as a living human being until I die.
· I have a right to maintain a sense of hopefulness, however changing its focus may be.
· I have the right to be cared for by those who can maintain a sense of hopefulness,
However changing this might be.
· I have the right to express my feelings and emotions about my approaching death in my own way.
· I have the right to participate in decisions concerning my care.
· I have the right to expect continuing medical and nursing attention even though “cure” goals must be changed to “comfort” goals.
· I have the right not to die alone.
· I have the right to be free from pain.
· I have the right to have my questions answered honestly.
· I have the right not to be deceived.
· I have the right to have help from and for my family in accepting my death.
· I have the right to die in peace and dignity.
· I have the right to retain my individuality and not be judged for my decisions, which may be contrary to beliefs of others.
· I have the right to discuss and enlarge my religious and/or spiritual experiences, whatever these may mean to others.
· I have the right to expect that the sanctity of the human body will be respected after death.
· I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death.”

So, the sad part to me, when I encounter a family who wants to maintain secrets, it is not only because of the lack of respect and dignity for the dying person’s ability to make decisions regarding their own dying, it is also because, the process of dying is as much a spiritual process as it is a physical one. It can be a truly beautiful one, if the dying person and their family members allow the hospice team to support them, educate them, and provide resources for them to open up to the spiritual journey. Those who have the courage to move beyond the fear, and embrace the journey before them, most often relate that it is an experience that they wouldn’t trade for anything.

A Reason, A Season and a Lifetime

I had quite an amazing experience a few months ago. We had a hospice patient who came on one day and died the next, so none of us got to know him or his family very well. But his last name was the same, very uncommon name of a very dear friend of mine from Seminary, who died our second year, of Liver Cancer. I called the daughter of our patient to offer condolences, as part of our bereavement follow up. But as a part of our conversation, I asked her if by chance she had family from Montana. She said yes. To make a long story short, she is my friend's cousin! We had a delightful conversation about him. (He died 25 years ago!).
But it was when I got off the phone I thought about him more and realized what an amazing impact Mark had on my life, even though we only knew each other for a little over a year. When he was diagnosed, we had a few from the seminary who went to sing and pray for healing, and then told him to get out of his bed and walk. Mark told them to stop their healing experiments on him, and leave him alone. The second group came in and gave him a cassette tape with a "special message." His mom listened to it before she would consider giving it to him. The message was that the reason he was dying was because of unconfessed sin in his life! Let's just say, she did a ceremonial burning and Mark never heard the tape. She then asked him who he really wanted to see. He made a list of 6 people, of whom I was honored to be included.

But, it was because of Mark that I pursued Hospital chaplaincy training. I went and took an internship at a local hospital, and followed that with a part time job at another hospital, and followed that up with almost 2 year residency in CPE.(Clinical Pastoral Education). It is because of Mark that my passion is Pastoral Care, and why I am a Spiritual Care Counselor today! So, in a sense, he was in my life for just a short season, but for a major reason, that effected my lifetime!! And here I am 25 years later, as the Spiritual Care Counselor for his cousins! WHOA!! Talk about coming full circle! I asked his cousin about Mark's parents. She told me his dad died, but to her knowledge his mom was still living. His cousin gave me her address and I wrote her a letter about how Mark impacted my life. A message any mom would want to hear. I got a response back a few months ago from Mark's sister, thanking me for the letter and informing me that it arrived just a few short months after her mom's death. But she said how much she appreciated hearing about my experience, and that Mark was still remembered. Just had to share this with all of you. A very poignant day indeed!
Susan

Tom

One of the greatest lessons I have learned about grief for myself is that we can never anticipate how we might respond when we lose someone close to us. Our responses will most likely surprise even us. My older and only brother died 7 years ago of a sudden heart attack. Tom was 2 years older than me, and we had gone through times (as most brothers and sisters do) of intense closeness, and separation. At the time of his death, we were unfortunately in a time of separation.

One Sat. morning in August of 2001, I went down to my office at the church to get another commentary for my sermon the next morning. It was there that I received a phone call from my mom, that Tom had been found dead in his home. He was a builder and was all dressed and ready to go to work on a project at one of his friend's. The coffee pot was full, and all he had left to do was put his boots on. Hearing the news, was so unbelievable. I screamed, "NO, NOT TOM!" I am one of the blessed people who is surrounded by close friends and thus did not have to experience this pain alone. Within minutes of getting to my home, I had a dozen close friends in my living room, and someone who would drive my son and I home. The next 2 weeks are a blur mixed with facing my parents, planning the memorial service, and all the other tasks at the time of death. The emotions of grief came at me as waves of an ocean: sometimes bowling me over, receding and then returning, but more gently.

Elizabeth Kubler-Ross spoke of Grief as shock, denial, bargaining, anger, depression, and finally acceptance. And while I know these emotions exist, not everyone will experience them all, and they may experience one or more phase multiple times. But I have also experienced grief as a time of movement from orientation, to disorientation, to re-orientation. With Tom's death came a time of disorientation, because so much of how I defined myself was now changed forever. I was a sister to one brother. I was one of two children in a family. I now had no sibings, and am an only child. It has been a time, over the last 7 years of reorienting myself to who I am now, and what all the implications of Tom's absence means practically, as well as spiritually. It is a time of answering the question of who I am now without Tom. With that comes who I became because of him; this one person who shared my genetics and my history, my experiences, my joys, my sorrows.

And a big piece of my grief process was and has been how I could resolve the fact that we weren't speaking at the time of his death. Attempts for reconciliation had been made for which I am grateful. The gift for me was that I found a letter I had written to Tom in attempts to reconcile, in his home after his death. I read the letter and truly believed, even with the new information that he had died, I would not change what I had said, and that I had expressed my love for him. It was important to me that he know I loved him deeply. It was that letter that enabled me to let our silence and separation go. I forgave him and myself.

So who am I today? I am still a sister, a daughter, a friend, a pastor. And in the moments when I struggle with caring for elderly parents alone, I think how wonderful it will be for my parents when it is their time to go. They will have one child on this side of life and one on the other. I can hold their hand here, and Tom can take them by the hand and lead them to the Jesus they love, and to their family members who have gone before.

A Gaelic Blessing:

Deep peace of the running wave to you;
Deep peace of the flowing air to you;
Deep peace of the quiet earth to you;
Deep peace of the shining stars to you;
Deep peace of the gentle night to you;
Moon and Stars pour out their healing light to you;
Deep peace to you, the light of the world to you,
Deep peace to you.

Belief; An Affirmation for Those Who Have Lost

This statement was written by James E. Miller. I came across it in a packet of statements from Hospice Sabbath. I found it very profound and have used it in the context of Bereavement services for our hospice, as well as at Memorial Services for our patients. I want to share it here with you as well.

" I believe there is no denying it: It hurts to lose.
It hurts to lose a cherished relationship with another,
or a significant part of one's own self.
It can hurt to lose that which has united one with the past,
or that which has beckoned one into the future.
It is painful to feel diminished or abandoned,
to be left behind or left alone.
Yet I believe there is more to losing than just the hurt and the pain.
For there are other experiences that loss can call forth.
I believe courage often appears,
However quietly it is expressed
However easily it goes unnoticed by others;
The courage to be strong enough to surrender,
The fortitude to be firm enough to be flexible.
I believe a time of loss can be a time of learning unlike any other,
And that it can teach some of life's most valuable lessons.


In act of losing there is something to be found.
In the act of letting go, there is something to be grasped.
In the act of saying "goodbye" there is a "hello" to be heard.
For I believe living with loss is about beginnings as well as endings.
And grieving is a matter of life more than death.
And growing is a matter of mind and heart and soul more than of body.
And loving is a matter of eternity more than of time.
Finally, I believe in the promising paradoxes of loss.


In the midst of darkness, there can come great Light.
At the bottom of despair, there can appear a great Hope.
And deep within lonliness, there can dwell a great Love.
I believe these things because others have shown the way-
Others who have lost and have then grown through their losing.
Others who have suffered and then found new meaning.
So I know I am not alone; I am accompanied, day after night, night after day.


************

I hope this statement brings you blessing and comfort, for those of you who may be experiencing a loss of a loved one. I first read this shortly after my brother's sudden death at the age of 46. That was 7 years ago now, and I miss him terribly still, but hopefully, I can take what I have learned out of my own grief process, and pass on the comfort that I have received.

A New Beginning

well here I go, another beginning in the blogosphere. I am a pastor who has found a passion as a hospice spiritual care counselor in the Los Angeles area. I have found it a wonderful privilege to listen and to help individuals to come to a place of peace, and to address their questions of faith. I don't claim to have all the answers, and the process of coming to peace is different for each person. Each of us have different questions, and different stories. But I believe in a God who loves unconditionally, who seeks each of us, accepts us, and is abundant in grace. So hopefully, in this blog I can share some stories of individuals I have encountered in these last few years. The stories of peoples'experiences, and how they have touched me as well. As a spiritual counselor, I would be remiss if I didn't allow the stories of faith and spirit touch me, and speak to me, and inform my own journey. I would hope that if I stopped allowing others' journies to touch my own, I would quit with the understanding that I had somehow been hardened to the realities and the power of the Spiritual journey as someone dies. A journey that not only affects the patient, but their families, and all with whom they encounter along the way.