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Care of the dying: a sublime vocation

30 November, 1999

Carers for the dying have a sublime and sensitive vocation. They need to be aware of their own motivation. They should not deny the reality of the coming death so patients and carers can share memories and deal with past hurts. Philip Fogarty SJ explains.

Having worked for some years as a volunteer hospice chaplain, there is a passage in St. Matthew’s Gospel that I feel can speak to carers who look after those who are the dying:

‘When the Son of Man comes in his glory, escorted by the angels, then he will take his seat on his throne of glory. All the nations of the earth will be assembled before him and he will separate people one from another as the shepherd separates sheep from goats. He will place the sheep on his right hand and the goats on his left. Then the king will say to those on his right hand, “Come, you whom my Father has blessed, take for your heritage the kingdom prepared for you since the foundation of the world. For I was hungry and you gave me food; I was thirsty and you gave me drink; I was a stranger and you made me welcome; naked and you clothed me, sick and you visited me, in prison and you came to see me… I tell you solemnly, in so far as you did this to one of the least of these brother and sisters of mine, you did it to me”.’ (Mt.25:31-41)

Carers who look after the dying or those who are suffering from serious illness are doing more than just being of service to those in need; they are serving the Risen Lord in a very special way.

Carers do, in fact, feed the hungry, give drink to the thirsty, and visit people who often feel imprisoned in their bodies as well as in their homes or facilities. How successfully they serve those who are suffering depends on the attitude of mind they bring to the task. But it is always important to remember that theirs is a sublime vocation, a calling made by Christ in the Gospel: not always an easy one and, at times, it can even feel as if one is carrying one’s cross.

When people care for someone who is dying, it is important to remember that they are entering into a person’s private world – a world at its most vulnerable. Patients face this most difficult of moments in varied ways. Some wear their hearts on their sleeves in the trial they are going though. Others are always freshly groomed and smiling. Some may suffer from a form of depression.

There are all sorts of combinations of this self-presentation, and it is important to notice how these dynamics are at work in the dying person. Some get exhausted being nice, and so it is important to provide some boundaries for them with regard to visitors. Some are cranky and demanding, either unable to concern themselves about others because of their pain, or are inclined to take it out on whoever is around, even those they love the most.

It is helpful not to take such swipes too personally and to be as direct and as honest as one can be in responding to them. Sometimes it can even be helpful to risk a comeback, testing behaviour in order to check the real meaning of the patient’s negative response.

True carers are people who are not content merely to dispense medications, provide meals or simply chat about the weather. They should want to be part of whatever the patient permits, and at times help them see things that they may not want to see at first: the seriousness of the patient’s illness, or how Christ fits into the whole picture, when the patient is ready for it. This calls for tremendous tact and delicacy.

There is a need to strike a balance between complete non-judgmental disinterest and a desire to be of complete service. Carers embody God’s loving desire to meet and serve those who suffer as they truly are, not as we might like them to be.

Dying patients may sometimes put on a good face for their family members and their carers so they do not appear to be a burden. However, it may also be to protect themselves from owning publicly what is happening to them and of having to express the very vulnerable and often unpleasant feelings they may have at such a time. Taking or refusing medicines and food can become tools in this game, prayer and one’s relationship to God can, too.

There is an awesome spectrum of meanings we humans find in suffering, from I am being punished for something (which I may or may not feel is just) to a sublime offering of oneself as a victim for the sins of the world. Some don’t even bother ,to search for a meaning, expressing frustration or silent endurance: It’s just the way it is. There is nothing I can do about it.

In the midst of this complex web of needs and motives, loves and fears, walk the carers, carrying the baggage of their own needs, motives and fears. Why do I act as a carer? Do I get a sense of power from others’ helplessness? Does it make me put my own ailments and losses in perspective? Along with genuinely wanting to alleviate human suffering, do I also have motives that are less altruistic, such as wanting to be needed, or refusing to deal with my own fears of pain and death?

To realize that many of these mixed motives are present, and not be paralysed by them, is always a challenge. However, if we see less beautiful sides of ourselves and are not blown away by them, we are more likely to convey, through our genuine acceptance, that patients are free to be themselves with us. This is good for carers and patients – indeed the best of medicine.

When carers, especially spouses or family members, are looking after someone who is dying, they sometimes try to hide reality from the patient, saying things like, You will be up and around in no time. Often, of course, the patient knows that what a loved one is saying is untrue. Wishing to protect their carers, and not cause them grief, they acquiesce in the game. However, by failing to acknowledge the reality of the coming death, carers and patients can lose a great opportunity: of sharing memories, of expressing love, of dealing with past hurts or estrangements.

For all their mixed motives, carers are called to a sublime, if difficult, vocation, especially if they remember the words of Christ: Whatever you do for one of these least brothers and sisters of mine, you do for me. This can be a real source of strength and consolation as they assist their loved ones on their final journeys to the One who alone can fulfil all the longings of the human heart.

This article first appeared in The Messenger (March 2008), a publication of the Irish Jesuits.