As a hospital chaplain, I met Mrs. Corrigan in an office adjacent to her oncologist’s office. She had just been talking with him about her terminal illness and about non-curative, comfort-care plans. Mrs. Corrigan was facing the end of her life from a metastatic form of cancer. As a patient now living at home, she had previously undergone many surgeries, radiation treatments, and chemotherapy. She had indicated that she wanted to see a chaplain for a series of spiritual care visits.
She appeared to be in her mid-sixties, heavy-set, and had a commanding manner. She introduced herself by showing me a picture from when she had been bald due to chemotherapy. Photographed from above, it depicted her smiling face beneath an entire scalp decorated with a henna tattoo. She said with pride that it had been in her local paper. I liked her spirit, turning her hair loss into creative body art. If she was going to get a lot of stares, she might as well make the most of it. We spoke about what it was like to lose her hair and her grief about some of the losses she had endured during the course of her illness.
She went on to share with me that she frequently missed her husband’s company at home. He would be downstairs on his computer, while she felt neglected upstairs, resting in their bedroom. I inquired if she had asked for him to come upstairs when she felt lonely like that. She seemed surprised that I had asked. “He should know already,” she snapped back. Smiling, I took a humorous flight of fancy, “Oh, so he reads minds? He knows what you feel even without your telling him? He’s magic!” She seemed a little taken aback, but then began smiling. “You might need to tell him that you want his company, that you feel lonely,” I seriously suggested. She considered that, and reluctantly agreed, “I could try.”
As she told it, her life involved a series of broken relationships – with physicians, nurses, her sister, etc. She blamed others for causing her physical pain, neglecting her, and being emotionally hurtful toward her. She was never at fault in these estrangements. As she described each situation, I asked her what she could do to improve these relationships, to reach out, to communicate her needs. I embodied the Light intentionally as a Truth-Teller. I empathized with her when I could, and I also challenged her to take some responsibility in her relationships. Over time, during our visits together, she began to report some successes in reconciling with her medical caregivers and her sister.
She made this turn-around deliberately. She had long been a devoted Episcopalian choir member, not because she believed in God – she didn’t – but because she liked to sing. Then one Sunday, during a worship service near Christmas, she made the conscious decision to enjoy the time she had left with others, however long that would be.
She dropped the weight of her resentments and forgave everyone, including herself. She realized this was something she could do. As a Quaker, I would say she experienced the Light in a new way. It seemed miraculous on the one hand, and on the other hand, it seemed mundanely obvious that she could take some responsibility to improve her relationships. She began to praise her physicians as being warm and caring. She began to enjoy phone conversations and a renewed relationship with her previously estranged sister.
Mrs. Corrigan’s deepest spiritual need – to love and be loved – had not been met during most of her life. However, she was transformed by her experience of the Light during one church service and during her relationship with me.
Healing happens in relationships. I experienced this with many patients. In Mrs. Corrigan’s case, I embodied the Light as a Truth-Teller, helping her see how she was opposing the movements of Love. Such an embodiment is common in the Quaker tradition. Friends stand up against wrong – like John Woolman challenging particular slave-owners while visiting them in their homes. The Light embodied by a Truth-Teller is like a mirror, showing a person what is not working and helping them see how to achieve reconciliation. Even at the end of life, people can grow spiritually.
Through my work providing spiritual care in hospital and outpatient settings, I learned that all people carry three core spiritual needs, regardless of other differences. By virtue of being human, created with that of God within us, we each carry: the need to love and be loved, the need to find meaning and direction, and the need to find self-worth and belonging in community. When we are in a crisis of any kind, such as facing our mortality at the end of life, one of these three core spiritual needs will emerge predominantly. When I assess which spiritual need is emerging in a patient, I can embody the Light in a way that becomes healing to the person. (This article is too brief to describe the research studies that I conducted at the University of California San Francisco Medical Center to explore my theory and practices of spiritual care.)
The grief of separation from our loved ones by death is agonizing. I have felt this personally through the deaths of my parents, a stepchild, and other loved ones. As we grow older, new deaths and new griefs tap into the inner well of grief within each of us. We can experience some healing from grief, but not completely; there is never a way of “getting over it” or “getting closure.” However, I have found for me and for my patients that holding a spiritual framework for understanding death can be enormously helpful. Based upon my own experiences in providing spiritual care to families coping with death, I believe that people who lack a spiritual perspective find the separation of death more difficult.
I further believe that when we are separated by death, our love for our loved one does not end. The poet wrote, “For love is as strong as death, more powerful than the grave.” (Song of Songs 8:6) Our love and connection continue even though we can no longer see, hear, or touch our loved one. Learning from individuals’ near-death experiences, I believe that dying people universally experience a sense of going toward a Light and feel that Light to be loving and pleasant, so much so that sometimes they do not want to return to this life. In interacting with my father as he was dying, he described his vision of the other side as warm and comfortable. After his death, I had a powerful dream of him in which we talked in our familiar way, and I was impressed that he was waiting for my mother to join him. Sometimes dreams can speak to us of a spiritual reality.
Also, I believe that we will know our loved ones when we join them in death. Their essences will be the same after this life as they are now. Just as Jesus’ friends recognized his voice and his appearance after his death (albeit with some initial difficulty), I think we will be reunited one day in a place where there is no more “mourning, nor crying, nor pain.” (Rev. 21:4) Since no one knows with certainty what happens after death, we can only have our own beliefs, and Quakers do not emphasize or require particular beliefs.
Given the human need for ritual to accompany important transitions in life, Friends hold gatherings to memorialize our loved ones in the community of our meetings. How we need one another when we are grieving! The kindness of others means so much at these times. Friends embody the Light as we console and support each other. As one older patient told me, “Wherever two or three are touchin’ and agreein,’ God is right there in the mess.”
In caring for people facing the separation of death, I have often been reminded that “something more” is present when we are together. The intimacy of sharing, the grace-filled moments, the “openings” of awareness and insight, the trustful surrender into the Eternal Mystery, the forgiveness, and words of Love – these may be totally unforeseen and transforming, perhaps even more so because they occur in ordinary surroundings. These touching and surprising moments are “gathered” meetings in the Light. What is Mystery is sensed as influencing the present for the purpose of healing, even when physical healing is no longer possible.
Ms. Applebaum was a woman struggling with end-stage breast cancer, spread to her bones. When we met, she recounted her long history with this disease and her exceptional status as a long-term survivor. She had several decisions to make as she grew sicker and lost her ability to walk. Living alone in a rented, upstairs apartment meant the total loss of mobility. Without a partner or caregiver, she contemplated moving. As a Jewish woman, she wondered if burial or cremation would be preferable. Cremation had negative cultural significance because of the Holocaust. Her ability to help other people was now hindered by her physical limitations. Still, she could write powerful poetry to inform healthcare workers about the need to be treated as a suffering, fellow human being, rather than “a case” or “an exceptional patient.”
I could easily sense that Ms. Applebuam’s core spiritual need was for meaning and direction. We focused on what was important to her in the time that she had left. I embodied the Light as a Guide to her, by helping her to discern her own heart’s desire in her decision-making, ignoring the outward voices of others.
Her physician gave her the opportunity to read some of her poetry to the Palliative Care Team and to several classes in the Medical School, which gave her a sense of purpose near the end of her life. I also supported her in receiving guidance from the Hebrew Bible and her own faith tradition to inform her decision-making and sense of meaning. As she grew along these lines, she grew closer to her own understanding of God.
Where Mrs. Corrigan’s strongest core need was to love and be loved, and where Ms. Applebaum felt most strongly the need for meaning and direction, I saw in my patient Mr. Lee the strongest core need for finding of self-worth and belonging in community. The community in which a person belongs may be of any type – a faith community, a club, a team, an interest group, or even a family.
Mr. Lee was the patriarch of a large Chinese family. He wanted his eldest son to make decisions for him at the end of his life. Yet he also had some strong feelings. He was suffering from kidney failure; he felt tired and wanted to let go. He no longer wanted to pursue dialysis, although his eldest son and family wanted him “to keep fighting.” It was difficult for him to state his wishes to his son and the rest of his family.
I met with his family separately to discuss their grief over his imminent death. In my experience, when family members have the opportunity to grieve, they are more able to make freer decisions and to listen to what their dying loved one wants. I discussed with the family the great love and sacrifice it would take for them to let him go. We talked about his wishes and faced the reality that he was the one suffering the most. We talked about all the ways they would miss him and how painful it would be. We also talked about the great love they had for him and their desire not to prolong his suffering, especially if he indicated that he no longer wanted treatments to prolong his life.
I facilitated a meeting with the family and Mr. Lee, indicating what he had told me earlier. They were able to express their love to him as husband and father. As they grieved together, they decided to do as he wished and to discontinue dialysis. They took him to a hospice, so that they could comfort him, feed him his favorite foods, and be with him as he died. With Mr. Lee, I embodied the Light as a Valuer, validating his own self-worth, the important role he held in his family – and his desire to discontinue medical interventions. I listened deeply to him and his family, helping them to process their grief and begin to say a good good-bye. They were able to say to one another: I love you, I forgive you, and please forgive me. They faced the separation of death together.
All of us can embody the Light to one another in various ways – Truth-Teller, Guide, Valuer, and more. We start by watching for spiritual needs in others, and then we wait for the Light to emerge through us in response. ~~~
Michele Shields is the Director of Spiritual Care Services Emerita and Research Scholar at the University of California San Francisco Medical Center. She is a member of Honolulu Friends Meeting (PYM).
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