By Paul Robertson
Jesus’ reminder to his followers to “visit the sick” (Mt. 25:35-45) is at the core of pastoral care responsibilities. (See also Mt. 7:12, Gal. 6:10; 1 Pet. 3:8, Mt. 10:8, Is. 41:10, Rom 12:14, and Js. 5:14-15) I remember how inadequate I felt when I first began making hospital visits (over 50 years ago). I had a course in pastoral care in my seminary training, but quite honestly, I found it inadequate in preparing me for visiting hospital patients in the real world of their pain and suffering. So many of the religious cliches I had learned such as, “It’s going to be ok,” “I’m sure it will work out,” “God has a plan,” “God is just testing you,” and “God has something for you to learn” seemed hollow and offered little in the way of help or hope. I soon realized I felt quite disingenuous offering promises that I could not guarantee.
I want to share some of what I have learned about visiting hospitals patients that I have found to be helpful. Hopefully, there will be concepts for you to consider. Some you will agree with and others you may not.
I am sharing these thoughts from several perspectives. First, I have tried to listen to what patients have taught me through the years. Some of that has come through my own pastoral visits. But much that I have learned has come though the experiences of my students as I worked with them as an Association for Clinical Pastoral Education Certified Educator.
In addition, I am sharing from my experiences as a cancer patient. I was diagnosed with Mantle Cell Lymphoma (MCL) in 2013. MCL is a terminal cancer. At the time, I was given a three-to-five year average life expectancy. I am grateful to God to still be “above ground” nine years later. Though much of my experience as a cancer patient has been as an outpatient, I have had several in-patient experiences.
Much of what I am sharing here was in fact shared with a gathering of chaplains in the Texas Medical System when I was in the midst of my cancer journey and after having been hospitalized. Thus, my thoughts are written out of the context of working with chaplains who are visiting patients in an interfaith setting. As pastors, when visiting patients, there is a different context in that the pastor normally has a prior relationship with the patient and is often of the same religious persuasion. However, I think the concepts I am sharing generally apply to the parish setting as well.
Some Unhelpful Approaches
Let me begin by offering some brief comments about approaches and attitudes that I have found to not be helpful in visiting patients. I will simply put these in the form of a list, with brief explanations.
- Spiritual Bias: The tendency to hold stereotyped views of other faith groups, other religions and spirituality.
- Spiritual Myopia: Difficulty seeing the spiritual dimension of problems and solutions outside of one’s own religious perspective.
- Spiritual Timidity: The fear of addressing spirituality in pastoral care arising out of anxiety, lack of understanding, fear of offending, or judgmental attitudes, etc.
- Spiritual Over-enthusiasm: The tendency to see “religion” as the root of all problems or the source of all solutions.
- Spiritual Cockiness: Overestimation of one’s own level of competency in pastoral care of those with a different spirituality, based on one’s personal spirituality.
- Spiritual Presumptuousness: Assuming that one has the answers/solutions for the patient before exploring the patient’s needs and resources.
- Spiritual Fixing: Using stained-glass language that is not fit for helping people when life is hard. Turning sacred stories/texts into “fix-it” formulas. The urge to offer definitive, simple solutions to complex problems—intolerance of ambiguity.
- Spiritual Interrogation: Getting so locked into asking questions as “the” way to understand a patient’s world so that the conversation seems more like an interrogation.
- Spiritual Denial: Failing to reckon with the reality that we are all mortal. Offering platitudes of hope when the reality is that sometimes things will not get better, at least on this earth.
- Spiritual Magic: Offering formulas and steps for bending and controlling the terrible realities around us.
- Spiritual Deafness: Ears that don’t hear. Thinking that one is a good listener, but unaware of or not practicing active listening skills.
Some Basic Considerations
I am not offering these thoughts in some hierarchal order. Further, this is a primer. There are other skills that one may use in pastoral care. But I believe these are foundational skills that most often need to precede the use of other more advanced skills.
First, remember your patients by name.
This may seem obvious. But the reality is that patients in a hospital often feel like a number.
The protocol for much of my treatment has been that the first question I am asked is, “What’s your number?” That is usually followed by “Can you verify your birthdate?” Then, usually, the procedure/process/next step begins. Sometimes, hospital personnel call me by name, but not too often. As a patient, behind curtains, I at times heard staff referring to patients by room numbers. I wonder if they know how degrading that can feel.
I appreciate concern for privacy and accuracy. I get it. But, I so appreciate hearing my name called. Simply calling me by name helps me to feel human again, to remember that I am more than a “cog in a wheel,” or an experiment, or a number in a clinical trial. Calling me by name reminds me that I am valued.
I am reminded of a scene in the movie “Patch Adams.” In it, Robin William plays a medical student, Patch Adams, in training. In one scene he is with a group of medical residents making rounds. The physician leading the group stands at the head of the bed and goes through a long list of symptoms, diagnoses and prognoses. Listening, the patient appears to be in obvious distress. The lead physician then asks the residents, “Are there any questions?” Patch, standing way in the back, sheepishly raises his hand and asks, “What’s her name?” The physician looks at him as if he is crazy…the group starts to move on to the next “number” (patient). While passing by, Patch pauses, looks at the patient in her eyes and asks, “What’s your name? She responds “Mary” and she smiles. Her face radiated joy that she felt validated as a human being.
Always remember that patients are human beings of worth and are alive and not just sick objects to be treated.
Second, give your patients the freedom to say “No.”
While this may be more relevant for chaplains than pastors, I think the principle applies to both.
As a patient, I learned that when most of the hospital staff knock on the door and say, “May I come in?” they are really not asking a question. Rather they are making a statement, “I am coming in…” Most often, they come in before I can answer.
My suggestion: Stop…wait…let the patient decide. I can promise, that means a lot. For you see, most of the time patients in the hospital feel powerless. I have often said that a hospital is an “anxiety house.” Just think of some of the losses that occur: trust, mobility, privacy, time, what is done to one’s body, what one’s body can do, control over emotions, identity, purpose and meaning, just to name a few. These losses and lack of control lead to anxiety.
Being a patient is a time of the real loss of dignity. It feels at time like every orifice in one’s body is being probed.
But, in a small way by asking and waiting, caregivers give the patient just a little control. And that can be liberating and empowering.
Third, learn to be with your patient.
My experience has been that too often “pastors” want to control the patient, fix the patient, or make the patient feel better. Often what patients most need is for you just to walk alongside them as they journey through their illness.
Chris Hedges wrote about his father, who was a pastor, in Losing Moses on the Freeway: “I asked him once when I was a teenager what he said to bereaved families when he went to the farmhouses after the funerals of loved ones. Surely, I thought, even my father with his close proximity to disease and death and grief would have some wisdom to impart. ‘Mostly,’ he answered, ‘I make the coffee.’ It was his presence, more than anything he could say, which mattered.”
In my Christian tradition, there is a wonderful Greek word that describes this process perfectly: kenosis—the emptying of self. Skilled listening requires one “to empty oneself.” An empty, open state allows for deep listening. Pastors and chaplains need to set aside their prejudices, frames of reference and desires in order to experience as far as possible the patient’s world from the inside, and to set aside one’s self temporarily and totally accept the other.
Fourth, learn to empathize, not just sympathize.
Some caregivers just do not seem to get it. They do not connect with patients. They seem to be afraid of losing their “objectivity.” They do not seem to be concerned about how the patient feels or thinks. When they say, “I am sorry,” somehow it does not always feel real.
I am reminded of the dean’s speech in the “Patch Adams” movie when he was speaking to the incoming class. “We’re going to train the humanity out of you and make you something better. We’re going to make you doctors.”
Whoa! Remember, patients are not just a disease; they are persons who have a disease. The reality is that patients are most often really anxious with strong emotions what are just under the surface. They leak out. They often have little control or ability to channel these emotions. Too often we are afraid of my emotions. As a pastoral caregiver, you can be a sanctuary where they can be safely expressed.
As a caregiver, have the interest and take the time to know and understand what it is like for your patients. Try to put yourself in their shoes. When you do this well, your patients will feel heard and understood. They will become more aware of their feelings. They will share more. They will feel your relationship with them at a deeper level. They will feel validated and relieved. They will feel closer to God.
The choice is to be engaged but not enmeshed on the one hand, or disengaged on the other hand. The bottom line is that good pastoral caregivers develop their empathic radar and have the capacity to step into another’s shoes—to see and understand the patient’s world from their perspective.
Fifth, learn to listen deeply.
When chaplains and pastors are at their best, they do not focus on giving advice (which most patients do not want or need), telling others they should feel the way the caregiver does (which invalidates their feelings, offends, pressures, and controls), trying to solve problems (which makes patients feel underestimated and disempowered), or doing things that patients can and need to do for themselves (which harms their self-esteem).
Instead, what they need to do first is listen. Patients urgently need support, trust, and encouragement. Rachel Remen, in My Grandfather’s Blessing, writes, “Listening is the oldest and perhaps the most powerful tool of healing. It is often through the quality of our listening and not the wisdom of our words that we are able to effect the most profound changes in the people around us.…Listening creates a holy silence.”
When patients feel listened to, they feel loved. “Listening is a magnetic and strange thing, a creative force….When we are listened to, it creates us, makes us unfold and expand. Ideas actually begin to grow within us and come to life.” (Brenda Ueland, Strength to Your Sword Arm)
Sixth, offering healing and not just curing.
I do not know about you, but I get discouraged and even angry when folks offer me cures (physical in nature) rather than healing (wholeness). It almost feels that some want to resort to magic and offer formulas for controlling the terrible around me and controlling even God. I do not want people trying to “fix me” or trying to control God.
What I think is helpful for patients is to invite them to walk in freedom even in the midst of their brokenness, to help them remember that cure is temporary and healing is eternal, and to remind them that God is sitting with them in the midst of their pain. That in fact facilitates healing.
Calvin Miller has written a book titled The Philippian Fragment. It is a collection of fictitious letters written by a first century pastor, Eusebius, to his pastoral mentor Clement. In one of those letters, he writes of his encounter with Helen of Heierapolis, a traveling healer:
“Helen is different [than other healers]. She came to Philippi with a conviction that God loves the suffering and she is determined to participate with God in that love. I met her in the synagogue when she was talking with a group of blind beggars. I was surprised that she didn’t even try to heal [cure] them, but bought each of them a new cane and reminded them that the curbs on Casesar’s Boulevard were especially high…. She is not much of a show woman, I’m afraid. She just mixes with humanity in order to take divinity as far as it will go….Sister Helen opened a great crusade in Philippi on Thursday and she is the sensation of the leper colony. She rarely does anything that one could call a miracle. Last week she laid hands on a crippled boy and was not able to heal him, but she gave him a new pair of crutches and promised to take him for a walk in the park here in Philippi. Yesterday with my own eyes I saw her pass an amputee selling styluses. She touched his legs and cried, ‘Grow back! Grow back! In the name of Jesus of Nazareth grow back!’…What’s a faith healer to do with an amputee that refuses to grow legs on command? She sat down with the little man, crossed her legs on the cold pavement, and began selling styluses herself….He smiled and said, ‘Do you heal everyone this way?’ ‘It is better to heal with promises than to promise healing [curing].’” (pp. 24-25)
What’s a pastor or chaplain to do when “cure” won’t come? Offer healing, not promises of cure. Remind your patients with your presence and words that God is with them in their suffering and participate in that love.
“Mix with humanity in order to take divinity as far as it will go.”
Seventh, with your presence and words, remind your patients of the sacred.
I have learned that patients often do not think about the sacred too much while you are there, while you are talking. After all, they are sick and dealing with a lot at the time. But after you have gone, as they reflect, they realize that God was with them in a special way. As a result, they do not feel as alone. They realize afresh that God cares.
Irvin Yalom tells a story about a friend’s final days in her horrible fight with cancer, and the news that her surgeon informed her that he had “nothing more to offer.” “What is wrong with doctors?” she said. “Why don’t they understand the importance of sheer presence? Why can’t they realize that the very moment they have nothing else to offer is the moment they are most needed?”
Connecting with a higher power, can be a powerful coping mechanism and needs to be respected by the entire medical team. In one survey I read, 87 percent of patients said that spirituality was important in their lives. Fifty-one percent to 77 percent considered religion to be important.
As pastors and chaplains, we need to nurture the role of the sacred in our patients’ lives. At the same time, I cannot over stress how important it is to understand the spiritual needs and resources of the patients first. It is not helpful to offer or try to give someone resources that are important for you, but that might not be important for them.
Remember, by being there, you show them a glimpse of God’s face.
There is a lot more that could be said about making hospitals visits. And there is more that can at times be done (such as teaching, preaching exhorting, guiding, reconciling, and liberating, etc.). But I do not think we can accomplish much else until we have first done these basics. And at times that is enough.
I want to close with a poem by John Fox.
When Someone Deeply Listens to You
When someone deeply listens to you
it is like holding out a dented cup
you’ve had since childhood
and watching it fill up with
cold, fresh water.
When it balances on top of the brim,
you are understood.
When it overflows and touches your skin,
you are loved.
When someone deeply listens to you
the room where you stay
starts a new life
and the place where you wrote
your first poem
begins to glow in your mind’s eye.
It is as if gold has been discovered!
When someone deeply listens to you
your bare feet are on the earth
and a beloved land that seemed distant
is now at home within you.
You really cannot go wrong by starting with listening. As you understand your patients, you will discover paths to empower them to find strength and assurance in what are often difficult times.
Your patients may not always remember or even have the opportunity to say, “Thank You.” On their behalf and as one who has been a patient and has been cared for by chaplains and pastors, let me say,
“Thank you, Chaplain (Pastor) for visiting me when I was sick.”
Paul E. Robertson is a retired hospital chaplain and educator who currently lives in Sugar Land, Texas. He is a former professor of theology at New Orleans Baptist Theological Seminary and later became director of Clinical Pastoral Education and chaplaincy services at Memorial Hermann Health Care System in Houston. He is a graduate of Mississippi College and New Orleans Seminary, where he earned both the master of divinity degree and a Ph.D. in New Testament and Greek.