Quote of the week!

"At the moment of death, we will not be judged according to the number of good deeds we have done or by the diplomas we have received. We will be judged according to the love we have put into our work." Mother Teresa

God is Still Speaking…

When I walked into Sally’s room, there was little change. The progression of Alzheimer’s marched on down its deadly path. She was no longer able to walk, take care of herself, or make her needs known. Her words were few and seemed mostly random as she laid back in the broada-chair (a form of modern geri-chair). Breakfast and lunch still stained her blouse as a baby doll, that a kind aide had left, lay cuddled in her old, wrinkled arms.

I knelt beside Sally’s chair and greeted her. Her little-girl giggle seemed so out of place in the frail body that waited on the cusp of death. Her face seemed to shine (probably the active imagination of one who so wanted to change the day for the better) when I suggested that we go outside and sit in the sunshine for our visit.

Once outside there was little to say beyond comments about the weather or how one was feeling. For such situations (when conversations seem to escape the clients’ abilities) I move into a routine, hoping to find something to bring peace, and the clients’ awareness of God’s presence. I played several old, familiar sacred hymns on my MP3 player and read the common verses of the Bible.

As I offered prayer, in preparation to leave, I felt Sally’s hand reach up and touch my cheek. When I opened my eyes, with her hand resting on my cheek, I was looking into her face from a foot away. Sally was trying to talk. This in and of itself was not unusual, for many such patients wish to talk, and sometimes do, in a random, nonsensical manner.

However, Sally’s voice was less than random and it felt directed to me from the heart of God. This is what she said with her hand on my cheek, “Why… (the dots here represent pauses)… you’re troubled… why… you don’t have to be… God knows… God knows… God knows… take care of you… God knows… (long pause)… He knows… You’re a teacher… a teacher… you’ve always been!” She pulled my hand to her mouth, kissed it, and whispered, “I love you!”

By this time, tears were running down my face as I realized, once again, that God had used the voice of the demented to speak to me and remind me of His presence, His love, and His calling. Someone asked me the other day why God does not speak much anymore. I responded that He was speaking just as much today as He always has, the problem is that nobody is listening. God is still speaking to you, and I feel compelled to ask you, “Are you listening?”

Dementia is no respecter of persons...

Dementia walks the sacred halls of the world’s cathedrals, among the vast wealth of Wall Street, and among the hovels of the poorest of our world. Slowly creeping where it is not bidden, getting a grip in the minds of the great, dementia marches relentlessly on and will not be deterred from its aimless end. No weapon has ever been formed against it successfully; there is no slowing its insistence upon devouring the mental faculties of both the very intelligent and the very ignorant. It destroys relationships, careers, educations, families, even the ability to appreciate the very simple pleasures of life (chocolate, grandkids, and flowers). No matter how devastating dementia is to all involved, no matter how degrading it is to each victim, and no matter how sure death is to the one diagnosed, each victim remains the creation of God, the child of its maker, and the love of his/her family.

With 58 % (33 of 57) of my case load involving some form of dementia (Alzheimer’s, CVA, Parkinson’s, non-specific Dementia) as their primary cause of pending death and another 19 % (11 of 57) with non-specific Debility as their primary cause of death who are also suffering from varying levels of dementia, dementia has been on my mind a whole lot this summer. Further, and even more importantly, I must ask the difficult questions. First, how does one effectively minister to people with dementia? Second, how does one draw the family back into the relationship without hurting them or creating a further schism between the demented and the family?

“People rarely lose interest in things they have enjoyed throughout their lives simply because they are experiencing declines in mental function. If their activities can be modified and simplified to meet their changing abilities, they can continue to enjoy things that caused them pleasure in the past and so retain an important aspect of their identities.”

Jennifer Hay, Alzheimer’s and Dementia (People’s Medical Society)

While these words were not written for the clergy, I think they have great wisdom that provides guidelines for those ministering to those with dementia. Further, they demonstrate the need for a good initial assessment of the client and the client’s family. Through a series of informal interviews and research into the client’s life, it is often easy for clergy to determine what was/is important to the client and what has caused them pleasure. Hay also goes on to use the example that clients to whom music was important can continue to find pleasure in music, even though dementia has taken its toll. Many people have found prayer, Scriptures, and sacred hymns to provide immense pleasure, comfort, and peace throughout their lives. The chaplain of the demented can easily provide these simple pleasures/tasks routinely to their clients with little difficulty. It has even been true in many cases, when the source of one’s pleasure is ‘unknown,’ it can be determined even in the non-verbal through experimentation. It amazes and thrills me to pull my phone from my pocket (doubles as an mp3 player), play an old hymn like “Amazing Grace,” and watch the same non-verbal client’s mouth drop open, occasionally see a tear make its way through the wrinkles of his aged face, or the demented Pentecostal raise her hands and shout in a feeble voice, “Hallelujah!”  I have even watched non-verbal, non-responsive clients mouth the 23rd Psalm and/or the “Lord’s Prayer” in the final moments of their lives. All this and more can, and usually does, thrill the families of the demented client.

The next question, “How does one draw the family back into the relationship without hurting them or creating a further schism between the demented and the family?” is not so easily answered, due to the multiplicity of human nature. What will help one family rarely will be the same answer for the next family. I call them the wall huggers, and there are at least a few by every deathbed. In some cases the entire family are wall huggers. I arrive at the room and they are hugging the walls, or maybe propping them up (sometimes it is hard to tell), and nobody is by the bed. Consequently the client dies alone, even though the ones that love them most are only a few feet away. I have found that direct request rarely works (“Why don’t you take the hand of your mother?”). Appealing to the altruistic natures of the family usually only works occasionally, and generally only briefly, by making the family feel guilty. The most successful thing I have done is through example. This, however, takes time, which is a valuable commodity that is often unavailable.

The example that I try to set is as follows. The main thing I try to do when entering the room is to make contact with the client through touch and voice. First, getting close to the client, so they are aware on some level that there is an additional person with them, is important for many because they often cannot see well. Second, I think making physical contact through holding hands or touching the face adds an addition point of contact and closeness. Third, voice contact through often one-sided conversation, provides addition bonding. Types of voice contact can be as simple as a description of how the day is going to devotional or scriptural readings. A fourth type of contact that is difficult for many, but one in which I find great pleasure, is stepping for a while into their alternate reality (chasing butterflies in an imaginary park, catching the ‘biggest’ fish, truck driving cross-country, or watching the bears play on the steps of the church across the street). If time will allow, family will usually follow the example that is set for them by people who, they figure, know how to deal with the demented. I often demonstrate to families the value of sacred hymns and the reading of favorite Bible passages. It is also from the above posture that I can quote/read Scripture, play or sing sacred hymns, and/or offer individualized, personal prayers. Unfortunately time is an enemy, and there have been many times that the most I could accomplish was to briefly provide the above before the client stepped across the divide, with no time for the family to release the wall and join me and the client by the bed.

A God Who Never Changes

Hebrews 13:7-8 (TMNT)  “Appreciate your pastoral leaders who gave you the Word of God. Take a good look at the way they live [and die], and let their faithfulness instruct you, as well as their truthfulness. There should be a consistency that runs through us all. For Jesus doesn’t change—yesterday, today, tomorrow, he’s always totally himself.”

In a world of flux and drastic change, there are few places that change is more obvious than in the Intensive Care Unit (ICU) of most hospitals. Lives, careers, and families are altered forever by death, disease, and disability. I stood by the beds of many such cases in the last few years and was made even more aware of my own impotence and fragility, either to alter my own course or to personally alter the courses of those to whom I minister.

One particular 79-year-old gentleman with an advanced case of gangrene in his right leg was facing immediate amputation of the same. His wife introduced me to him and informed me that he was a retired Baptist preacher and had been a prison chaplain for many years. He and I talked together for 15-plus minutes before we got around to talking about the pending amputation. I asked him how the amputation was going to change his life (I was trying to determine how well he was accepting the inevitable). He thought for several minutes as we sat there in silence. Then he spoke only a few words, but rarely has any man spoken more powerful and profound words. He said in a quiet voice, “Well, God doesn’t change!”

Those words were words I needed to hear to put my ministry in the ICU into its proper perspective. Not that I expected that of myself I could do anything, but it is my nature to want to do something myself to help. But I am only an often-feeble channel through which our Lord can minister to the sick and dying. While the lives of people around me are changing in drastic ways, “God doesn’t change!” I really think that this is one of the significant messages that I could and probably should communicate, both in words and deeds, to our patients. In spite of one’s situation, God does not change. He is still there in every way He has always been. Calvary and the death of Jesus did not change God. Persecution throughout the history of the world has not changed God. God is still God, the same God who is without beginning or ending.

I also found it of special interest that the above gentleman’s life demonstrated the principles of Hebrews 13:7-8. As I took a good look at this “retired” pastoral leader, his faithfulness was instructing those around him. His consistency was not altered by the situation, but rather it was a demonstration of God’s faithfulness and permanence throughout life, even unto death. While I had come to minister, he in turn was looking to minister to me and to shore up the faith of those around him.

I have thought much about this since those few words were spoken into my heart. I don’t think I have walked into a single room that I have not felt the effect of those words ministering strength and comfort to my heart and soul. My prayer is that my life will be lived in such a manner that it will demonstrate the faithfulness and permanence of “Jesus [who] doesn’t change—yesterday, today, tomorrow, [who is] always totally Himself.”

Presence is often more than enough...

Like many, such encounters are neither planned nor predictable, but rather come as a surprise and provide fodder for reflection and intrinsic rewards for a long time. I met Lewis one cold, wintery Saturday morning when the nurse informed me that she had a man who had been given a poor diagnosis of cancer, and he was not dealing with it very well. She wanted to know, since I was there visiting another patient, if I could stop in and visit him. I agreed, and because of the nature of the timing and the quick visit (as you will see), I knew no more about the background of the patient as person and patient than what I have articulated here.


The following is the scenario as I experienced it: When I arrive at the client’s room, Lewis is sitting up with his legs crossed on a flat hospital bed, and the hospital table is across the bed in front of him. On the table are an open briefcase, a cell phone, and miscellaneous papers. Beside Lewis on the bed are several, obviously already read, local and national newspapers, including the Wall Street Journal. Lewis looks young for 52 and relatively healthy and alert. On the end of his nose is perched a pair of reading glasses. He is wearing designer-type sweats that look out of place in the ICU, his hair is well-groomed, he is clean-shaven, and looks like he is waiting to play the part of a businessman in a movie. As a matter of fact, Lewis, in general, looks out of place in the ICU and makes me wonder what he is doing there. Lewis looks like he should be at the gym instead of the ICU.

Lewis looks up as I enter, “Hello, Lewis, my name is Joey, and I am the chaplain this weekend here at…”

“[Profanity], Get the h… out of here!” much to my surprise he again said loudly, “GET OUT!”

This is not what I expected, and the nurse must have had her wires crossed. As I began backing out, “I’m sorry! The nurse thought you might like a visit!”

“JUST GET OUT!” he repeats now, hollering and including a few non-repeatable adjectives.

“Goodbye, and have a nice day!” I walk out the door as I refuse to indulge his narcissistic need to rile me.

When I am about 10 feet from the door and moving fast, another holler is heard from the room, “CHAPLAIN, GET BACK IN HERE!”

As my brain and feet have a tug-of-war about what we are going to do, I turn around and return to the door and just stick my head in. There is no sense in going in too far just to get thrown out again, “Yes!” I replied rather timidly.

Not as loudly, “Get back in here!”

My timidity is showing when I take one step inside the door, “You told me to get out!”

Now talking in an almost normal voice, but as one who is used to giving orders, “I know, but I want to ask you a question!”

As I walk over to the bed, I am thinking fast and trying to get back in control of the situation, “May I take a seat?”

Lewis seems surprised by my remaining ability to ask if I can be seated, but points to the chair by the bed and says, “Help yourself.”

Sitting down slowly and crossing my legs and leaning back in what I call my counselor position, calmly asking, “So what would you like to ask me?”

With an exasperated expression, like one would sometimes address a foolish child, Lewis asks, “Just what did you think you were going to do when you came in here? Just march in here, mumble some holy prayer, and everything would change for the better?”

With a chuckle, “Maybe! Certainly wouldn’t hurt to try prayer, but probably not what I would have done first.” I will choose my battle, and this is not the one I want to fight, especially since I am convinced that this is not the basis of his anger; besides, there is some truth and humor in his question/postulation.

He fails to see the humor, “It’s a good thing you chaplains are not paid! It would be a waste of money!

“I’m sure some would agree with you!” Again, to fight this battle here would not solve anything or benefit Lewis at all, and I am sure it would be a lost cause. It would not help my cause here to let him know that I am paid, and paid rather well, considering.

Continuing his questioning above, “Seriously, what would you have liked to accomplish here when you were going to visit me?” Aha, now we are getting to the question behind the question. His professional curiosity will kill the proverbial cat.

With a little smile on my face, “Oh, I already accomplished what I set out to do!” I say this before I really have time to think about what I am saying. I sense a power greater than myself; God’s Holy Spirit is present and filling my mouth in my hour of need.

Surprise is obvious on his face, “Oh, and what is that?” I too am trying to mask the surprise on my face and figure out what to say next.

“Are you sure you want me to explain this to you? It might be better if we just let it work on you slowly!” God’s Spirit has not left me, and by now I think I know where He is leading this conversation. While this is apropos to what I had been studying, this is the first time it has been quickened to my mind while speaking to a patient.

The proverbial hook is set in Lewis’ psyche, and he is not about to let me go, “No, I want to know what you think you accomplished in those few seconds!”

“Ok, we will start with the most obvious. First, you are no longer sitting here alone fretting over your diagnosis. You have me (foolish, time and money-wasting as I am) to think about and talk to.” I say this light- heartedly with a chuckle (♫ A spoon full of sugar... ♪).

He too chuckles, “I guess you got me there! You might be good for something! What else do you think you accomplished?”

Taking my time, I postulate a second reason, knowing that I am hitting closer to home with each reason, “Another obvious thing is that I am indirectly relieving some of your stress by giving you a place to vent some of your frustration!”

To my surprise, Lewis quickly agrees. This time he is more serious, “Yeah, you’re right again! I felt like my head was going to explode when you came in, and now I am feeling that less. What else?” While before his bitterness and anger made him blind to help, when offered, he now seems almost eager to know what I am going to say next.

“Well, the other is not as easy to see, but I will try to explain. First, your records say that you are Christian. Is that correct?” It is now time to use what I have learned during my recent studies and hope that I am on target.

He nods, “Yes, I have been a member of [some name like Crestfield Community Church] all my life. I usually go every week.”

Here goes my best, “You see, Lewis, there is a thing we chaplains call ‘presence’. As ministers of Christ, we don’t represent the hospital or ourselves, even though what we do reflects on both. No, we represent Christ! Even though you did not want me to visit earlier, just the fact that you realized I was a chaplain triggered memories in your mind. The fact that you go to church weekly tells me there has been lots of meaning attached to church and the things of God throughout your life. I don’t know what those things are exactly, but let me speculate for a moment. For some, the chaplain’s presence might trigger the memory of a godly mother who bandaged their skinned knees and said prayers, that reminds you today that God is here, and He does care about your diagnosis. For others, they memorized the 23rd Psalm, and the chaplain’s presence reminds them that God is their Shepherd and that even though you now walk through the valley of the shadow of death, you don’t have to fear such evil for God is with you…”

By this time a tear rolls down his cheek as Lewis interrupts, “Stop! Stop! You win! I can’t take any more. Please go now! You’re right. Forgive me for earlier. Just go!” He wipes his tear away with a tissue.

With a little smile, “Ok, I will go. I just wanted to answer your question. Don’t worry about earlier. Considering what you’re going through, it’s understandable. Would you like me to say one of those holy prayers before I leave?”

Much subdued, “Yeah, like you said, it couldn’t hurt!”

“Dear Lord, you see the fear and the pain…” I begin a short prayer and then quietly leave the room. My work is done, but the Master’s has only just begun.

A huge blow hit Lewis, when the doctors told him that he had cancer and was facing the possibility of an early death, which left his faith reeling. His misguided anger at me as the chaplain actually gave God the loophole through which to minister and provide salve for his fear and pain. It is always amazing to see God’s Spirit at work in people’s lives and how He uses me to be an instrument of His Spirit, even though I often have no forewarning of the situation.