Healing the Dying

Dr Gareth Tuckwell writes of the experience of dying both for the person concerned and for their carers.


This article was first published in the Autumn 2001 issue of Chrism. The author's profile below is from the same date

Dr Gareth Tuckwell has been Medical Director of Burrswood, the Christian Centre for Health Care and Ministry in Kent, for over 11 years. Before that he was a GP in Epsom, where he was a shared leader of an Anglican church and on the Bishop of Guildford's advisory panel for the ministry of healing. He has also practised in New Zealand where he was very involved with Speydon Baptist Church in Christchurch, which had a remarkable healing ministry. He is co-author of 'A Question of Healing' with the Revd David Flagg, and a contributor to several other books.

Guild of St Raphael

Healing the Dying

Despite efforts to break the conspiracy of silence surrounding death, we still live in a culture of death denial and suppression. It is sad that our emphasis on achievement ethics and consumer mentality pays attention to death only when it is sensational and has commercial value It is strange that death should be ousted to the periphery of life when the death rate remains at 100%! As Emerson cynically wrote 'the only things certain in life are death and taxes'! Some doctors still equate death with failure, a comment supported by an American research paper that referred to death as 'negative patient care outcome'!

Bishop Hugh Montefiore talks of our irrational fear of death but perhaps we can also relate to Woody Allens's comment: 'It's not that I'm afraid of death, I just don't to be around when it happens!' Perhaps this is why our culture has created the illusion of dying being painless and ' easy.

Looking back to Christmas a decade ago, my father was dying, struggling to stay in control in the face of the confusion of overwhelming infection, The family prayed at the bedside: "Father God, take your servant to yourself; we release him from our love and ask that you release him from any suffering or indignity". A hot hand squeezed mine in agreement and a few minutes later that prayer was answered - what might have lasted hours or days was over - the final healing had taken place. My father looked refreshed, peaceful and asleep. I paid my last respects by helping the district nurse to give him a last 'wash and brush up', before tidying up the bed. At this moment, all the reality of life seemed present - illness, death, humanity and eternal life. No more struggle, my father looked at home and secure - there was a sense that he made it and that all was well; expectancy had become reality and that 'great adventure' that he had been anticipating had begun. The stillness of the room was deafening, reminding me of the hush of excitement and exhaustion that surrounds a mother and child when labour is over and a new life has begun in a wonderful world, that 'eternal vista of life', that could never have been dreamt of No wonder we struggle with being borne, when we have no evidence of life beyond!

Life became very real for my father in the last year of his life, when he knew that his treatment was just buying time. Different things mattered, horizons narrowed, goals were set at increasing distance away, and his Christian faith became a source of great strength. At first he began bargaining with God: "I don't want to die yet; there's so much I want to do". The church prayed for him, he was anointed with oil for healing and hands were laid on him in the name of Jesus. There rebelliousness left him, the smile of inner health returned and his body grew weaker. Three weeks before his death, after taking Holy Communion, he shared with his vicar, "You know, all those prayers for my healing were answered. The depression I was going into a year ago has left me completely and so has all fear of dying: I know it won't be long now". He was learning to live in the tension which seems so much at the heart of Christianity in which the present agony is permeated with joy or the promise of joy.

My father had been packing his 'bags' over the last year in many thoughtful ways - having the exterior of his house painted making it easier to sell, resigning in all he was involved in once he felt his successors were sufficiently briefed and writing to those he knew he would not see again. In the last three weeks, after he had elected to have no further treatment, each member of the family was seen, pearls of wisdom for the future were shared, directions for the funeral and memorial service were given and healing tears were shed Life was lived to the end and death was achieved rather than surrendered to. This is what healing the dying is all about.

In one sense we are all dying. Most of us have probably seen death all too close and some of us may have had to come to terms with the fact that we have a progressive or possibly fatal disease. The anticipation of death can be a positive experience, especially if we realise that the time to look at the reality of our own death is now. If we fail to look at the fears surrounding our own death, we will only share our anxieties and vulnerability leaving those we love to die alone, even when we remain at their side. We fill our lives with preoccupations in order not to face death. If we become free to look our death in the face in the midst of life then the energies caught up in maintaining a denial of reality can be released for trusting, hoping and loving. How can we be in involved in healing the dying, when our hands seem empty and all we have to share is our feeling of helplessness, blurred by our watering eyes? Once the medical team has relieved the physical pain, then the pain that has social, spiritual or emotional roots may surface, making our ability to be alongside all important. Effective ministry, as with good medicine, demands the care of the whole person - body, mind and spirit; indeed a whole person cannot be broken into parts. In that healing occurs in an environment that allows growth towards wholeness, attending to the many dimensions of pain brings opportunity for us to be involved in creating space for that persons growth, even as death approaches The community of carers, with the one who is sick, has to work to build and hold space for the Holy Spirit to work in. At Burrswood, we find that the dying need the community - it's skills, fellowship , care and love, yet the community needs the dying to keep it's eyes on eternal issues and not to be focused on the minutiae which wrongly seem critical to every day living. Sheila Cassidy writes, 'The world is not divided into 'needy sick' and 'gracious carers'; we must all take our turns in playing these roles Once we have grasped this truth, we are much freer because we are able not only to accept one another but also to value our own vulnerable humanity'. For the family, coping with terminal illness is more than a challenge - it is all consuming and entangles every corner of life. There are so many people to talk to, so many questions to ask, so many tasks to do The hopes of different treatments can quickly change into fears and failures. There is an exhausting emotional roller-coaster It's like having an unwanted and uninvited stranger in your home who seems to take up every moment of your day. Strangely perhaps, for carers the first task is to look after ourselves! We need to let others share the burdens and responsibilities as well as the joys and sadness We need to maintain our rhythm of life with rest, food and exercise. We need to feel free to spend time in prayer and in doing what we enjoy. We need to seek out someone who can actively listen to us so that they can help identify the source of our anger and our fear.

Having been heard, we are set free to listen. We listen with ears, our hearts and open minds. We listen for issues that need resolution, issues that need healing and reconciliation - with people, with God, with themselves We listen to the pain of parting, of dependence, of practical concern for the family, of hearing God and wondering how to respond - all this needs expression with the confidence that the depth of the agony will be heard and understood. There may be no space for growth until the whirling of the mind is stilled and the fears that encircle and torment are shared and their reality examined. There may be the fear of something unbearable, of deep sleep being mistaken for death, of failing to get help in a hurry, of being a burden, of being rejected in ugliness, of dying alone, of having no say in treatment decisions, of loss of control, of being misunderstood - all these fears can overwhelm and disable the rational mind. Listening reveals unfinished business, incomplete reconciliation, a lack of assurance that the family is ready to cope; hearing and resolving these problems brings release. Listening allows the mind space to untangle thoughts, concerns and relationships. It gives value to the one who feels of no value - it allows an entering into the other's pain. We need our questions heard and understood so much more than we need our questions answered. If we find ourselves in the listening role, we should perhaps resist the temptation to run for the pastor, they have chosen us. It is their truth they are searching for. On listening we discover some Christians are ashamed of their fear. They feel they are letting God and the Church down, and feel guilty We can encourage them. God gave us a fear of death as part of our equipment for living. It prevents us taking unnecessary risks. He gave it to us - He understands it - He will help us when we are afraid.

Listening can reveal a life story to be recorded or written down for posterity. Dying people are not so much dying as people, men and women living what ever time is left to them with a sense of urgency - they have messages for those they love but sometimes find it too hard to communicate these face to face.

As we spend more time with the one who is dying we will find them moving backwards and forwards between the different stages that most of us go through - denial, anger, bargaining, depression and acceptance.

Denial

Denial is common when a potentially fatal diagnosis is imparted and allows what cannot be endured to be ignored. For a short while life may be lived as if in a dream because reality is hell and the face smiles as if to prove nothing is wrong. During the journey towards death denial often comes, not from the dying person but from others. The news is too hard to bear and they pretend it is not true. A sick person may try to break through the family's denial by saying "I am getting weaker all the time and I can't see myself getting on my feet again" - but the family's response often indicates that the truth is too painful to be borne. The physician is greeted with "never tell her she is going to die - we know she couldn't handle it" and then the patient says to the nurse "Please don't tell the family how seriously ill I am. Worrying won't help them at all". A frustrating conspiracy arises in which everyone pretends that the sick person will recover. It takes tremendous energy to sustain this fiction and inevitably it increases a sense of isolation.

Anger

This arises from fear, helplessness, frustration and perhaps resentment. Carers will find it best to respond to the frustration rather than the anger.

Bargaining

The deals that sick people try to make with God are not often shared but if they are, you are privileged so it is best to listen with respect.

Depression

Dying is a crisis of parting from loved ones and feelings of sadness and depression should be honoured rather than dismissed. To dying people, comments along the lines of "You have had a good life" make light of their situation. Often no answer is needed as we journey alongside. Sometimes the reading of a psalm that articulates their cry can help their crisis of despair "My God, my God why have you forsaken me?" With death approaching there are many losses to face. Loss of this life - for a life on the other side Loss of me - no longer will it be possible to look, listen, smell, touch, talk, weep, sleep, make love, be warmed by the sun or be blown by the wind.... Loss of tomorrow - to enjoy, to experience, to influence, to give, to ask for forgiveness, to change. Loss of those we love - depriving them also of me, loss of the sense of safety and control, roles, strength. Some losses come early in the course of an illness, some come late, some losses come and leave almost unnoticed while some leave a deep wound.

Acceptance

With this stage, reality has taken precedence over hopes and dreams. They are going to die, Now the dying person just needs the presence of their chosen community of carers. They become detached and contentedly draw away from those they love - this can be painful and feel like rejection but it is very normal. Art, politics, sport ... they all fail to provoke the interest they did Interests are shed in favour of emotional bonds. At this time permission to die often eases agitation. We need to believe them when they tell us they are about to die. We have a chance to say the things we really want to and to prepare ourselves. We need to share the excitement when they tell us, "There are others in the room." This is too frequent an occurrence to be argued with or challenged. In some way this experience lifts loneliness. Some may sense the companionship of those who have died before us - or angels, or presence of light and love beyond description. Although this is beyond our understanding and stretches our theology, we can draw from it a quiet confidence in that wonderful world beyond that awaits those who know Christ in their hearts. Throughout this difficult journey of being alongside those who are dying we need to remember that the times when we are lost for an answer and feel we have nothing to give, maybe the very moments when we show true companionship, for the one who is sick perceives us to be as vulnerable as naked as they are. We will find there is a beautiful mutuality of relationship in that those alongside, if ready to receive, may receive so much - a sense of being valued, a realisation of which things in life are really important, the infectious sense of peace despite there being no treatment as such to offer, being included in the 'family', inspiration to continue through difficult situations of life, reassurance that what might seem chaotic is still all right: that imparts courage and provides encouragement to keep going.

As we are left deserted on the touch line, we slowly see that healing comes as we release the person who has died into Jesus' loving arms, and then love Jesus and those left behind with that same love which otherwise could be stifled in loneliness We must try not to allow the questions we cannot answer to limit the joyous certainties we already know. We have to realise that God's purposes for our lives are not measured by the length of our life. We must trust that the best is yet to be - there is nothing more glorious than to be with Christ.

Guild of St Raphael