A useful guide to being present and offering comfort to the dying and their families.

Megory Anderson was called to a vigil at the bedside of a friend who was dying one night. That experience was so powerful that she began working with others who needed help attending to those who were dying. Today Anderson is the executive director of the Sacred Dying Foundation in San Francisco, and trains others in the art of "vigiling," a way of attending to the needs of the dying.
This practical and concise handbook provides a brief overview of what to expect and how to respond to the needs of someone who is dying. Attending the Dying can be used by and for people of any faith perspective, as well as no particular faith. Chaplains, social workers, hospital-care workers, and friends or family of the dying will all find this a helpful companion for preparing themselves to be present to one of life's most sacred transitions.

Attending the Dying

A Handbook of Practical GuidelinesBy Megory Anderson

Morehouse Publishing

Copyright © 2005 Megory Anderson
All right reserved.
ISBN: 978-0-8192-2108-7

Contents

Chapter One

Death as a Sacred Event

I was sitting with an elderly woman who was close to dying. She had been moved from the hospital the week before to a skilled nursing facility. She wasn't strong enough to go home, and they didn't really know what else to do with her. Her name was Ida.

We chatted a bit on and off, but mostly she wanted to sleep. She seemed to find comfort in my holding her very frail hand. It was covered with deep bruises and I held it gently.

Mid-afternoon, a young-looking clergyman came through the door.

"Are you Ida?" he asked. "I'm Jim Robinson, the new assistant at St. Andrew's Church. I heard you weren't feeling well."

Ida opened one eye but then closed it and went back to sleep. I smiled at the man as he pulled up a chair.

Jim began to talk. "Is she asleep? I'm new at the church so I don't know everyone yet. Perhaps I should go. At my last church I was youth director, but at St. Andrew's they have me visiting hospitals and nursing homes."

He looked around nervously. "I think I like kids better than I like hospitals. You aren't expecting them to come in the room, are you, to do shots or needles or anything like that? I'll wait outside if that happens."

I murmured something sympathetically.

He continued. "I had Clinical Pastoral Education in seminary, but mostly I worked with vets and rehab. It was different than this. Hospitals make me nervous."

Ida opened one eye and commented wryly, "It took you long enough to get here."

"Well," he replied, "we're kind of busy at the church. There's Advent coming up and everything."

Ida closed her eyes again, and began talking. "I've been at that church for over sixty years. Don't talk to me about Advent. Why weren't you here before?"

The young priest looked down at the floor. "Ma'am, I got here as soon as I could."

"I was married at that altar," Ida told him, "and I raised my children there. I taught Sunday school, baked pies for the ECW, and was head of the altar guild for over twenty years. Every time the church needed something, I was there helping out. It was my duty."

She looked at him head-on, her eyes flaming with anger.

"Now that I'm alone and ready to die, you take your sweet time. Just because I can't do all those things anymore, do you think I'm not a member of the church? Sixty years I gave to God at that church, and now you can't bother with me!

"Let me tell you something, young man. You'd better have a better excuse than Advent coming up!"

I chuckled under my breath. This woman was not ready to die yet! As she turned to me and explained, her voice grew a bit calmer.

"In my day," she told me, "the church was everything. We didn't have much religion around the house. Church took care of all that.

"My children are all grown and moved away. My husband died years ago. I'm all alone. Do you know what that's like? And now this. I know I won't go home. I know I'll die in this bed. What am I supposed to do?"

Her eyes began to fill with tears.

The young clergyman spoke up. "Ma'am, I don't know what you want me to do. I guess I can find a prayer from the Prayer Book. And I can come back on Sunday with communion. Would you like that?"

"Harummph."

"Ida," I said. "Tell us what would make you feel better."

"Communion would help," she said. "But ... it's not enough. I mean, you young people are always in such a hurry. In and out. The body of Christ and good-bye. I'm dying. Isn't that reason enough to stay a few minutes?"

She looked at me again.

"Your sitting here feels nice. Sometimes I get afraid, and I can feel your hand, and that helps. And when I wake up, maybe I want to hear you tell me things. Like God is waiting for me and it will be all right. Or that I'll see Henry when I finally die. That would give me comfort."

"I have this daughter," she continued. "She lives in Connecticut now. She calls and says hello, and she was here when I first got sick. But now ... maybe I'd like to tell her some things before I go. I don't think the nurses will help much. But maybe you might," she said to me.

I spoke up. "Of course we'll call your daughter. That's no problem. What else can we do? Maybe someone from the church can come and sit with you. Read to you."

Her eyes brimmed with tears. "I'm so old now, and I'm tired. But I'm afraid to die. What happens? What if I don't go to heaven? What then? Old Reverend Jackson, he would have been here in a flash. But he's long gone. I guess I don't matter anymore." She turned her head into the pillow and I could hear the muffled cries.

I began brushing back her fine grey hair. It was so downy, like a baby's.

"It's all right," I said quietly. "It's all right."

Poor Jim looked so uncomfortable. I noticed, though, that he was carrying a Prayer Book with him.

"Why don't you read something, Jim? Find the Psalms and read to us. It may help."

He leafed through the pages and found what he was looking for. He began reading quietly from those familiar words, "The Lord is my Shepherd. I shall not want...."

As her crying began to soften, I asked Ida, "Can we figure this out together, Ida? Tell us what you need most. Do you want someone with you?"

She nodded. "I feel so afraid," she whispered. "As if no one even cares anymore."

"Jim will talk to people at church," I told her, "and they'll come sit with you."

Jim suggested, "Why don't I call the altar guild? I know they'll be happy to come. You're one of their own. And I'll be by on Sunday after services to bring you communion."

"Ida," I said, "perhaps we can find something for you to hold on to, to remind you that God is with you all the time. He isn't abandoning you, especially now. This is a very special time for you. You are getting ready to meet him."

I looked around the small room. On her bed stand there was a wadded-up linen handkerchief. It had beautiful embroidery around the edges. I opened it up and found a small beaded bracelet. The stones were a lovely shade of deep purple.

"That was my mama's," Ida said.

"It feels so lovely in my hands," I told her as I fingered the beads. "Very soothing. Do you want to hold it?"

She nodded and reached out for it.

"Ida, think about your mother and how much she loved you. She wanted to be with you, so she gave you this bracelet. When you hold it, think about her. Think about how much you're loved."

Ida brought the bracelet to her face and held it against her cheek. As she was cradling it, Jim came over and boldly began to anoint her.

"Ida, this oil is another way to remember how much God loves you. I'm putting it on your head and on your hands. Be protected and guarded as you lie here. Be healed of any pain you have. And remember that you are always in his arms."

There were tears coming down his face as he gently made the sign of the cross on her forehead and hands.

We stayed with her a bit longer as she slept. Her face was peaceful, and I knew it was going to be all right.

* * *

"At my last church I was youth director, but at St. Andrew's they have me visiting hospitals and nursing homes." I hear this kind of comment a lot from young clergy. A fundamental shift is occurring in our churches today. In earlier decades, much of the population in our mainline churches were members with young families. Now, many tend to be from an older generation. Our congregations are aging and they are dying. One problem, among many, is that clergy are not prepared to minister to the dying. Seminaries don't teach much beyond how to conduct funerals. There may be a few moments dedicated to pastoral care with the ill and the bereaved, but there is little in our curriculum about care for the dying.

This handbook is designed for any member of the clergy or lay pastoral care worker who is called to be at the side of someone who is dying. There are many other resources available for those who have just received a terminal diagnosis, or for someone who is recently bereaved. This is a handbook for care of the "actively dying," which, in medical terminology, means someone on his or her deathbed.

This work comes out of my own experience with the dying, which I've described in a book called Sacred Dying: Creating Rituals for Embracing the End of Life. The book has helped set the stage for an entire paradigm shift in how we, as people of faith, create community and ritual for our dying. I have sat at the deathbeds of more than two hundred people, and learned that there is a tremendous need for sacred presence when someone is at life's end. The church has fallen behind in its ministry to the dying. The Sacred Dying philosophy is that no one should have to die alone and abandoned, and that death is a sacred transition, one filled with grace and mystery. As a community of faith, I believe it is our responsibility to hold the space in which our brothers and sisters make the journey. If we fulfill our responsibility on this end, we can be assured that God will be waiting on the other one.

Throughout history, the community of faith has traditionally been present both physically and spiritually during a death to guide the dying into the afterlife. Only recently, in the age of medicine and technology, have we passed on this responsibility to hospitals and nursing homes. It is time to reclaim death and dying as a spiritual transition.

This handbook is recommended for the chaplain or pastoral care worker as a guide to the process of sitting with someone who is dying, of being spiritually present—of maintaining a vigil—until death occurs. This nuts-and- bolts informational guide for trained caregivers, both lay and ordained, will take you through the stages of the last days and hours of a person's life, answering many common questions and addressing spiritual needs. It suggests ways in which you might also be present after death, commending the soul in its journey to the afterlife and honoring the body left behind. This guide also helps with some difficult issues that can arise, such as how to confront the reality that death is imminent and how to respond to questions about the afterlife.

The guide is organized into three separate sections:

• Part I, "The Chaplain/Pastoral Caregiver's Role at the End of Life," describes what you can do in preparation for a sacred death.

• Part II, "Interacting with the Dying," describes the last stages of death and how you might respond. This includes how to "sit vigil" with the dying person. It also offers suggestions for rituals that might be possible immediately after the death occurs.

• Part III, "Assimilating Your Experience," addresses your own personal needs for reflection and processing after the death occurs.

The appendices offer more tools and information that you might find helpful. Appendix A examines situations that can challenge the chaplain, such as an emergency room death or a death that happens after life-support systems are removed. Appendix B, written by the Reverend Nancy Witt, who, besides being a member of the clergy, is a practicing social worker and a physical therapist, explores in more detail the physical and emotional phases people may experience as they die.

Chapter Two

Bringing the Sacred to Dying

Those who work with the dying, whether as dedicated career chaplains within a hospital or hospice, or as clergy or laypersons from a congregation within the general community, have a special calling. Being with the dying and their loved ones requires spiritual presence unlike any other.

This guide is based upon several key assumptions. First and foremost, the experience is about a spiritual process that is taking place for the person dying. Dying is often difficult, but it is always sacred. The role of the pastoral caregiver is to help make the dying experience as sacred as possible. No one deserves to die alone and abandoned. One of the key differences that distinguishes the work and philosophy of Sacred Dying from the work done by a hospice or a medical facility is its focus. Sacred Dying has arisen, in part, out of the necessity to address the particular needs of the person who is actually dying.

The medical community is doing its part to keep patients comfortable and pain free. Medicine focuses on life, on saving life and on prolonging life. When medicine no longer works, hospice may step in. Hospice focuses on the path that leads to death, and eases the person into that transition. As hospice has developed within the Medicare and insurance reimbursement environment in America, the time that hospice workers may spend with the dying person is often limited to proscribed visits, rather than to maintaining a vigil. Some hospice programs have strong volunteer programs that help to fill in the gaps in time with volunteers trained to follow a person through the dying process, and to provide support as they can. But without those volunteers, there is a gap in the continuum of care. And it is into that gap that we go.

It's our job to concentrate on the spiritual process of helping people move from life through death and into the afterlife. We often forget that death isn't just the medical process of the body shutting down—the spiritual process that is occurring at the same time is just as important and powerful. Once we realize that this spiritual process has its own signs and indicators, it is much easier to respond to the dying person's needs for forgiveness and letting go, for assurance of God's love and acceptance, by assuaging fears and anxieties about what is happening and where he or she is going. It is my experience that focusing on love and acceptance, even in the face of anxiety or dread, helps the dying person find the spark of love that is God. Whatever the needs of the dying person, whatever the situation we find ourselves in, this experience belongs to the one dying, and all focus should be on him or her. Being present in this way is often challenging, and it can be tempting to offer a quick fix or a platitude in lieu of real presence. But a quick prayer and laying on of hands doesn't always meet the ultimate needs of the dying.

This leads to our second assumption—that spiritual care at the end of life involves many things, but primarily it means presence. Vigiling with the dying person, providing spiritual presence until the very end, is not only recommended but is highly encouraged. If you're a chaplain or serve a busy congregation, you may not be able to sit vigil with the dying for hours at a time. Fortunately, you do not have to do this alone. You can also empower loved ones or family members, in addition to teams of pastoral caregivers, in the practice of Sacred Dying. You then serve as the facilitator guiding others in vigiling. Vigilers can sit quietly with the dying, read Scripture, play music, and use prayer to create sacred presence. It is a powerful ministry and one that can be shared within the community at large.

Preparing to Vigil

As you prepare to sit vigil, it's important to first bring yourself to a sacred place. Since there's no way of knowing ahead of time what the dying person may ask for or need, it is not a time to "plan" your vigil. Rather, you want to become centered and receptive to being 100 percent focused on the dying person's needs. Preparation at this time is about letting go of your own to-do list or agenda and being present to the person who is dying.

• Practice deep and even breathing to calm and focus yourself. Remember, the word inspiration literally means breathing in!

• Purify yourself. Wash your hands and face, not just to disinfect them, but also to wash away other concerns you may be carrying.

• Visualize setting your thoughts and concerns aside to focus completely on the dying person. Leave other things outside.

• Use prayer and meditation to bring yourself to a sacred place so that you can begin the vigil from a centered place.

• Recall any pre-vigil connection or conversations you've had with a dying person: reconnect to the dying person's wishes and needs.

• Pull together/bring appropriate tools (see page 22).

Creating Sacred Space

As a chaplain, you have the ability and the calling to set the stage for a good and holy death. Creating "sacred space" is one of the first steps in setting the environment apart from day-to-day issues, which in turn helps everyone present remember the sacredness of the event unfolding. Family members and loved ones often take their cues from you, the chaplain. If you honor the space and environment as something set apart, they will realize that the event taking place is holy.

The act of creating sacred space allows for privacy and intimacy; it also defines the physical space so that it can contain the vigil process. Whether you find yourself in a hospital room, a nursing home, or a private residence, the need stays the same: to create and hold a space that is holy in order for this death to happen peacefully. As you create sacred space in the dying person's location, you want to be creative but not intrusive. This is one of the "busy" times of vigiling, when you may be moving or cleaning things. However, this is not about what you like or find attractive. From this point on, your role as the chaplain or vigiler is to do what you sense is right for this particular dying person.

(Continues...)

Excerpted from Attending the Dyingby Megory Anderson Copyright © 2005 by Megory Anderson. Excerpted by permission of Morehouse Publishing. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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