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10/28/17

Hospice Chaplains and a Physician Talk about God , Suffering, and Dying

Yes, have the priest anoint me !
I don't want to die alone !
Play a  harp  for my father !
No, don't talk to me about God !


                                    But when this perishable [ body] will have put on [ what
                                    is ] imperishable…then will come about the saying…
                                   'O death, where is your sting ? '    ( the Apostle Paul, 
                                   1 Corinthians, 15: 54, 55 )



By Robert R. Schwarz

            This  report  is about  last words and thoughts of patients, people like you and me— dying in a  hospice.  It is also about  the necessary compassion and fortitude of  two chaplains  and a  physician who care for  these patients. Your Exodus Trekker reporter recently interviewed these three dedicated  caregivers at different hospices;   though having  varied  backgrounds ,they share  two strong  beliefs :  

Ø        Dying and suffering of patients  often evoke joyful life-defining moments from changed  relationships with loved ones and hospice caregivers.  
Ø       Much  of the  medical  profession and  public is  ignorant of  the true  hospice mission; equally important is that both doctors and family members of the dying should stop being shy or overly tactful when talking to each other about a patient's impending death 

                 We'll  start with Joseph…

        
  He is 62 and works the day shift  with two   chaplains—one is Jewish—at the Northwest Community Hospital  in Arlington Heights, Illinois . For 16 years he has cared for hundreds of the very sick, the suffering and the dying . Some are devout Christians , some have ceased being active in their faith tradition, and some are atheists .   Joseph  lived in a religious community and took vows of poverty, chastity, and obedience vows . " I am still loyal to those vows," he said.  He is a certified chaplain employed by the archdiocese  of Chicago and serves at the hospital  as coordinator of Catholic ministries .  It is often a leadership role,  but  Joseph's priority is to minister to  patients' spiritual comfort. 

            During our interview, Joseph often expressed himself as an evangelist might  ; he believes  that "Jesus invites all of us day by day to grow through dying and rising . "  This is especially true, he said, of hospice patients who, along with their caregivers , need to be aware of  this cycle . " I'm honored and privileged to hear  my patients share  their life stories." His check- list for  patient care-giving includes : listening with empathy, easing anxiety in times of their uncertainty, encouraging courage, and reminding them that God loves them. He emphasized,  "People need  to know that they are being cared for , " 

            Joseph's  expresses other  spiritual beliefs by painting them .  On his  office walls  are  abstract renderings of  paintings depicting  God, Jesus, and the Holy Spirit .  Several have cosmic or nature backgrounds . 

" Every One Should Die Well " 

         
Passion also comes  from 57-year-old Dr. Orlanda Mackie when  she talks about  her work as hospice and palliative care specialist at the enormously large ( 464 beds, 300 physicians) John H. Stroger Jr. Hospital of Cook County in Chicago. She prides herself as a "catalyst" for  meaningful dialogue between  herself and   her dying patients and their families.  "I always thought everyone  should die well, " she said .  " But what I do is not sad." .  She is assertive with medical opinions but one can easily perceive her as  a gift-bearing grandmother.  
                                
            Dr. Mackie was born in Stroger hospital, did her internship here, and   daily sees  as many at 12 patients ;  most are low income or indigent Afro-Americans and Hispanics . She considers her entire 20 years  here as  one life  milestone .  As an aside, she added,  '' My role is also to make sure that the Afro-American community  is educated  [ about dying ] so it can be empowered . "    

            Joe , our other chaplain,  is three years older than Joseph,  and has seen suffering and dying of nearly 150 patients since coming 2 ½ years ago  to Vista Hospice in  Waukegan, Illinois. He had been  director of  medical information and review at a pharmaceutical  company, and has been a  registered pharmacist since 1971 . Joe  was ordained a deacon in  2013 at Holy Name Cathedral in  Chicago. 

            Vista is not a faith-based hospital ,  but  Joe sees patients of all of denominations and once had to find a rabbi for a patient. Joe's  core beliefs are his   three P's:   pulse,  presence , and prayers.   Pulse  means Joe has to be a live person.  "Sometimes it’s more of a matter of bringing comfort to the family,"  he said ,  especially when "the patient is journeying to   this sacred period in his life, when they're getting ready to  transition from their earthly life to their eternal life. " 

            For Dr. Mackie , who is  a  practicing Roman Catholic ,   her most important life lesson  came from a  103-year-old Baptist woman for whom she was caring. Though her patient was  dying, "she had a "very positive attitude  until the end  , "  Dr, Mackie  related.  " What she taught me was to be grateful for every situation we have in life, whether good or bad . The key is to look at the situation and process it.  If a mistake, it doesn’t have to be a  mistake for the entire day. " 

            From some dying  patients, this physician occasionally hears a "confession" , like that of a  narcotic addict who told  her he had "broken bonds and bridges to his family ."  He admitted , " I did this all to myself," and now wanted  his family to take him back home . But  he doubted if they would forgive him. Dr. Mackie told him, " You know, we can blow up bridges but that doesn't  mean they can never be repaired. " 

" I'm Dying.  What Is God Doing for Me ? " 

     
Dr.Mackie in her examining room at  Stroger hospital
     Another patient,  when dying of cancer and when advised by his visiting mother that he should pray to God, replied angrily,  " For what?  Look at me . I'm dying. What is God doing for me?"  He had been confirmed in a Christian church. When his pain worsened, he told Dr. Mackie, " I don't want any more pain medicine. "  Puzzled, she asked why. He replied, " I need to suffer. "  Again, she  asked why.  "I'm not going to talk about it  anymore,"  he said.

            " I then asked him," Dr. Mackie said,  " if it was important for him to have the anointing of the sick by a priest ? , and he said 'yes. '   A priest came in and we left it at that." 

            Another patient of hers died an atheist . "I had told him I wasn't there to change his perception about God, that is not my skill set. But I respected his belief. "    (  Hospital chaplains cannot minister to patients unless the patient has requested  it. )     Do her patients ever talk about heaven?  "  I have to be honest with you," she said. " We move them out as quick as we can.  They don't even have time to process a lot of things. Some die quickly because we  get patients so advanced and so late. " (Stroger does not have an actual hospice unit but relies on four hospice stations outside the hospital. )           
            Religious faith has always played  a role in her medical practice, Dr. Mackie said. "When dealing with people who are impoverished, you have to have the energy to more forward and sometimes just leaning on your faith is what makes it happen.  " When she is down, her favorite prayer is Psalm 23.  "Yet,  sometimes I don't have anything to offer my patients except kind words. " 

            Dr. Mackie is  the youngest of four brothers and three sisters and  was  raised in the Chicago Afro-American community of Englewood , where she became  aware that a  "lot of people were dying there yet nobody  was talking about it.  And I  said, let's change  some of this and let's have a conversation. So that 's what led me into palliative care . "   Today Orlanda  is an advocate of open , honest "conversation "  between  hospice patients, their families, and especially doctors  , many of whom she maintains are "afraid "  to have an honest , no-holds-barred  dialogue about death and dying.   One of her biggest challenges is "to make people understand what I actually do. It's not all about dying. Not all my patients die. "  Before graduating from a medical school on the West Indies island  of Dominica, Dr.  Mackie  taught special education classes in a Chicago public school.    
 
What Motivated Them to Be  a Hospice Chaplain ?    
                 
            Obviously, a chaplain like Joseph or Joe  needs more that comfort  skills to be steadfast with compassion for  the suffering and  dying  day after day.  Joe and Joseph would agree that some aspects of hospice care money cannot buy. Is it something the  caregiver is born with, an attribute which develops  from self- discipline and experience ?  I asked Joseph. 

    
Joseph with two chaplain colleagues: The Rev. Janet Frystak
of Christ Victor Lutheran Church in Elk Grove, IL, and
The Rev. John Bushi, a  Mennonite from St. Peter Lutheran
Church in Schaumburg, IL.  
      He and  I  talked  in his small office on the hospital's third floor . ( The eight hospice unit beds are on the ninth floor. ) Joseph stands at  five-feet, six-inches and said humorously , " I'm shrinking. " . He has brown  eyes   and brownish black hair and wore a tie and  a button-down blue shirt. His voice today  was  a bit hoarse and often punctuated with exclamation points and outstretched palms.  He wanted to share heart-felt thoughts   and began to express them with colorful metaphors,  with a  sprinkle of metaphysics. 

    Joseph satisfied my curiosity by  relating two events .The first was his  surviving triple heart bypass surgery in late 2015 .  "The doctor told me [ afterwards ] ,  'Joseph, you're a miracle ' You survived it ! ' "

            "And now, Bob,  I'm a changed person as a result of that experience !  I look at life now in a much more hope-filled way. I really wasn't meant to survive this .There must be something that the Lord wants me to do. And so now I've been given a second chance ,  and so I'm not going to waste it because every minute of my time now is very valuable and important. I' m devoting my life and all my energies to those people who are grieving and suffering and dying. " 

            The other inciting experience which strengthened   the  calling of   Joseph's ministry occurred at  Lourdes, France, known for decades for testimonials from people who claimed they  had been  healed there of various illnesses and  disabilities . Joseph was standing at the cave site where the Virgin Mary  was seen by Saint Bernadette in  1858 ,  an apparition known today as Our Lady of Lourdes. He said that the  minute he touched the rock and the flowing  water  from the spring from which Bernadette had drunk,  he had goose bumps.  " I knew I was in a holy place. " 

            Joseph then help lift up the arm of a frail woman with an oxygen tank at her side  so she could touch what he had  just touched. "I looked at the expression on that sick person's face and sensed  that a peace, an indescribable   transformation had taken place in her. And this was affirming to  me that  the hospice work I was  doing is what I'm supposed to be doing. "  Though  the woman walked away with her oxygen tank with no outward appearance of being healed,  Joseph said ,  "I knew that she was healed emotionally and spiritually. "  

Dying to Harp Music ( really )

            A few days after our interview, I visited Joseph to check on a few facts. He was still feeling the emotions of an event two  days earlier in the room of dying man whose two daughters   One of the daughters  was thanking Joseph having brought a priest in to anoint  her father before he died.   She started to cry when she recalled that father had hired a harpist  for her wedding . " "Then she said," Joseph told me,  " ' I want to pay my father back and have a harp player here when he is dying.'" 
             " We do this at times; harp music gives a calming presence ." Joseph said. 

            Joseph left to room to fetch  a harpist named Tony , who soon arrived and started to play his harp.   Hospice harp music, Joseph explained, keeps rhythm with the patient's breathing.  The father could not  speak,  but Joseph noticed he  had been "tracking their conversation. " 

            The father died the next day. His wife had died in this same hospice.         

Joseph's favorite painting, The Goodness
      of Life .
Light does shine through our darkness
and difficulties, he  believes.   
Into the Light…a poem  by Joseph Marco
There often is no way to explain why our creator permits
            some things to happen.
To give meaning to life, to make sense out of it all, is only
            possible through the eyes of faith in a God who never
            ceases to love us.

God of day and night, you journey with us through
            darkness into light.
Your are love that  dispels the suffering of our heart
            and mine.

You are healing for the body.

Your are peaceful light that helps us live in  the
            hopefulness  of life.
           
            Amen. 


"It's the Sort of   Thing 
                                     the Spirit Leads You Into "                                

         
Deacon Joe outside a McDonald's after coffee with Bob 
Deacon Joe Casey thought about being a priest at age 15 .Though his mother occasionally nudged him to realize it , Joe , after two and  a half years in a seminary, knew he wasn't called to the priesthood.  " You know," he said, "it's the sort of thing the Spirit leads you into. "  As for hospice  work, he said he "sort of fell into it after years of working as a pharmacist and dealing with a lot of sick people. " 

            We had met for coffee at a McDonald's oasis on a toll way near  Lake Forest, Illinois. Joe  is six feet tall , has white hair and brown  eyes, and was wearing  blue jeans  and  a long-sleeved red and black check shirt. Joe is a mild- mannered man whose personality often includes a smile when he talks to you. Unlike Joseph, he is frugal with words; this begs a journalist  for follow-up questions .  He is married, has two sons, and was one of ten children . After his father died at age 36, leaving Joe's  mother  to raise five of them at  pre-school age ,  Joe , then only ten, began  paying room and board  to his mother by working in a drug store . 

            When asked  what events in  life shaped his the most, Joe had to  paused and  reflect. He went through a list of events: One of his brothers was  still- born;  three of his  high school classmates died ;  and, unbelievably, his father , uncle, and grandfather all died on a Dec. 19.  It all made Joe realize "that we are going to face a death and, because of that fact,  I'm not uncomfortable about talking about death . " Today he finds that many of his patients , though not uncomfortable when  talking about death to a stranger,  are so when speaking to  a  family member.  

            Unforgettable patients ?  Joe had just made a home visit to a World War  II  infantry veteran , a cancer patient ,  when much later he  remembered that he had never thanked him for this veteran's  service.   Joe learned that  his patient had been a German soldier in the war and was a "very strong  Christian " who emigrated to America .   "I didn't harbor any bitter feeling about him ," Joe said,  upon realizing   this man could have been shooting at  his  father, who had been an American combat soldier in Germany during the war. 

            Joe, who is  also a deacon in his church, also  recalled an elderly  patient  dying from cancer, who " made it absolutely clear he was an atheist " . ( Medicare requires that hospice patients be given an option to accept or decline chaplain visits ;  Joe and Joseph made it clear that giving religious care to a patient who has declined it  can do more harm than good. ) Joe's  patient said he could deal with dying but not  pain. His wife was a Catholic Christian.  Nevertheless, he agreed to seeing Joe every other week. Said Joe,  " We developed a friendship . We had a mutual respect for each other and didn't get into deep discussions but he would talk a bit about why he was convinced there was no God. I did not argue with him, nor try to convert him. " 

            One day Joe's  atheist friend , with his wife in the room, asked Joe  to arrange a funeral service for him   " His bones  were deteriorating and he was becoming slowly paralyzed," Joe said. . " He told me , ' at one time I hoped I would have no pain but now I have no feeling whatsoever ' "

            One week before his death  the man was unable to speak, and Joe read to him a chapter from a book written by the noted Catholic author, Fr. James Martin , S.J..  Joe told him to signal any time he wanted  Joe to stop reading. Joe read the entire chapter . 

            What was his reaction ? I asked Joe. " He showed me two thumbs up . "  Joe does not know if his patient at the end had  refused or accepted  Christian beliefs, though at the man's funeral Joe saw a crucifix above his casket. 

" We are dealing with people with denial and disbelief " 

      
Joseph giving communion in the hospital chapel to Eucharistic
ministers he has trained for their visits to shut-ins.  
    I asked  Joseph if any of his patients died still refusing to believe in any higher or  divine  power . " Yes, " he replied.  But added his belief  that  "in their own way they had  touched that higher power at the end. "   He said that perhaps people today "are more spiritual but  very much less religious. They are not interested in a structure where they are boxed  into believing in a certain way. "
            Joseph's comment   prompted the  question  of  " is this a good thing? "  Replied Joseph, "Yes, if it's good for them and it helps them dealing with suffering and dying. What I've learned is that we need to be present   with these people in a loving way, to accept them in the moment wherever they are, and bring them love, a listening presence, and compassion. Every day we are dealing with people who are dealing with denial and disbelief. 'Why do I have cancer, why is this happening to me? ' They are dealing with a lot of heavy stuff, and if I can bring a listening ear and a compassionate heart to them, then that's good. That's what any wonderful hospice program should be all about, and that 's what we do there. " 

            Joseph's  words made me recall  holding my mother's hand as she died while I prayed Psalm 23 ,  and  talking to my brother during his  last few,  pitiful  days on a hospice  respirator . 

            We talked about doubt and heaven and hell. Joseph agreed that the  last weapon of the devil is to sow doubt in the patient about God and heaven. He believes that at the very end of life of a person who has lived a wicked life and now still denies God's existence, that God "gives him a second chance " to convert.  Joseph offered no comment on hell ,  but did say   "we need to be accountable for the mistakes we have made if life. "  Family members of patients have asked Joseph questions about heaven and hell many times . Joseph  tells  them:  "There are a lot of things we don't understand " . He   assures them, however,  that " the Lord is in the midst of the suffering of their loved one. " 

            At 9:15 a.m. each morning Joseph  leads a group of six or more Catholic Eucharistic ministers from nearby parishes,   in a communion service in the hospital chapel. One of the ministers told this reporter that " Joseph has a real passion for what he does. He tries to train the best people for the job. "
            The act of leaving his office at day's end  sometimes saddens Joseph. To restore himself, he says he then needs to be alone in his  condominium.  After long  moments of silence,  he  might turn  on television and  watch "political stuff "—he says he's on the liberal and of things—or  go out with  his "supportive family of  friends " for a pizza. 

         
     But painting is what uplifts Joseph's spirits the most. He often uses scenes from nature as metaphors and symbols to express his core beliefs about dying, loss and grief , and  the cycle of human life such as the metamorphous of a caterpillar into a beautiful monarch butterfly.  Nature itself incited Joseph to paint ; he often went camping as an Eagle rank Boy Scout.  "All life," he said, "can be the ground work for growth ."    He cited the tree leaf which is green in summer and in fall is a "shimmering  gold or vibrant red color. Look at your own body: new cells are constantly replacing dead cells. We   have to go through loss, then death before we can get to    the other side, to resurrection. As a chaplain who daily sees people who are dying, I am able to see that process.  " ( "All of my art work has a resurrection theme to it, " he told  a retreat audience last Oct. 28 who had come to learn how to "put their feelings on paper." ) 

            On the wall today in the  hospice social worker's off ice hangs a colorful piece of art done by crayons by a woman while dying of cancer.  Knowing the woman was artistic, the staff  had brought her a coloring book, and she went to work on it.  "It was beautiful !"   Joseph exclaimed. "It looked like a stain glass window. It was one of the very few behaviors she had not lost. " 

Patients Dying Alone Make This Physician  Sad 

      
Dr. Orlanda Mackie, hours away from a joyful trip to Disney
Land , a birthday present to herself and nieces, and nephews
    When patients die alone sadden   Dr. Mackie .  "Sometimes I just can’t change that,  " she says with a sigh.  Listening to jazz, particularly that of deceased pianist Thelonias Monk ,  in the apartment she shares with her sister,  picks her up. " I listen to music all the time." She also  reads mysteries and  books about Afro-American history. There is no television set in her  apartment.  The doctor's favorite dish is baked chicken with rice   and vegetables .  " I eat that just about every day. "  He sister does the cooking. Perhaps Orlanda's greatest  pleasure is that trip on her birthdays  with nephews and nieces to Disneyland . That's where she was headed a few hours after our interview.

            Chaplain Joe sees an occasional movie and reads religious books, giving some away as  gifts such as the classic The Imitation of Christ.    He tries to forget  that  "worst experience " of his life: watching his adult son bury his own three-week-old son. But the tears which were welling up as Joe related this at McDonald's   , disappeared when our talk ended and he  told me of his plans to drive 12 hours to see his three grandchildren in Nashville, Tennessee.   
   
            When asked about his own death,  Joe replied —smiling , of course—"I will not have any epitaph on my tombstone. I'm being cremated. I've already purchased  a columbarium . It's just a ten-by-ten."

The End

            All comments are welcome.
rrschwarz7@wowway.com
© 2017 Robert R. Schwarz