Withholding or Withdrawing Treatment
“Living Wills” or Advance Directives
TRAINING LAY CAREGIVERS IN HOSPITAL VISITATION
Model 2– Recruiting and Networking
Model 3– Trained Lay Caregiving Teams
Charles A. Williams, M.D.
Department of Pediatrics
University of Florida
Foreword
Wayne E. Oates, Ph.D
For a long time this book by Pastor Lawrence Reimer and Chaplain James Wagner has been needed. The unique focus of the book is embodied in the personal dialogue between these two undershepherds of Jesus Christ, one a chaplain “inside” the hospital staff and the other a pastor visiting in the hospital from the “outside.”
I first sensed the need of such a book early in my ministry. I was a student chaplain in a program of clinical pastoral education. I visited and cared for a certain patient and her family. A year and a half later I became the pastor of the church of which she and her family were members. She had become ill again and was admitted to the same hospital. I was asked to visit her then as her pastor, from outside the hospital. The very atmosphere and content of the relationship and conversation was dramatically different! I concluded that one reason for this was that I related to her on a temporary—or “one-layer” basis, to use Wagner's and Reimer's term—when I was a student chaplain. I related to her on a many-layered basis when I was her pastor. Both relationships had their strengths, but both had their limitations. They needed each other. Likewise, I was not a part of the hospital staff as her pastor. She associated me with another place, her church, not the hospital. “Hospital” meant to her, “sick”; “Church” to her meant “well enough to go to church!” I am happy indeed to discover this book that brings these two perspectives into dialogue with each other in the persons of these authors.
It was not until I had been privileged to read this book that I found a serious discussion of what a pastor experiences when he or she visits in a hospital “from the outside” and how he or she can inform, shape, and enrich these experiences to the greatest benefit to the patient.
The training of a pastor is remarkably deficient in dealing with what it is like and what is needed to visit the hospital from the outside, as a parish pastor routinely does. Usually in seminary-related and other programs of clinical pastoral education, the student works from “within” the hospital staff. He or she moves along with well established pathways of communication with staff, patients, and families that have been built by the faithfulness and credibility of the chaplain-supervisor. More than he or she is aware, the student is in a protected situation. In gaining entrance to staff conferences, nursing report times at changes of shifts, and even being allowed to visit certain patients, the clinical pastoral education student has a way opened by reason of the chaplain supervisor's longer term relationship. No such luxury is available to the pastor of a church from the outside, ordinarily, and especially is this true of a pastor newly arrived in a parish situation.
Chaplain Wagner and Pastor Reimer have spoken to this need of the parish pastor to find his or her way systematically into the sphere of relationships in a hospital staff, among attending physicians, families, and patients in the modern hospital. They have the courage to say things that are obvious to a person who works full time in the hospital but are as unintelligible as a foreign language or custom to many pastors. Much of what is communicated within a hospital is in code words and terms and in nonverbally understood rituals that cause many pastors to feel that they are in a “foreign territory.” This book by Reimer and Wagner translates this “hospitalese” into pastorally meaningful concepts that both pastor and lay visitor can understand, appreciate, and appropriate.
Similarly, the hospital has an elaborate set of medical rituals of diagnosis, treatment plans, ways of prolonging life, responses to emergency threats to life, and caring for the desperately ill and dying patient. The authors of this manual make you comfortably aware of what these rituals are and what they mean. They give you concrete suggestions as to how, where, and when you can bring the rituals of your pastoral presence, your prayers, your reading of the healing grace of the Scriptures, and your infusion of the life of the church community into the support system of the patient. They emphasize the blend of your rituals or ways of doing things with those of the hospital community. The secret to the blending process is in your getting to know the staff, the attending physician, and the very personality of the corporate lives of the different kinds of hospitals in which you visit.
One thing these authors consistently express needs understanding here: they themselves very apparently like being ministers. They know that their identity as ministers is to them a unique gift related to the patient for example, the pastor has appropriate access to any patient that needs him or her. The pastor is welcome in all areas of the hospital and not restricted to a special area or kind of patient. The pastor, most of all, is the one skilled in the use of words, in the patient listening to and speaking with a sick person. I summary, the pastoral heart of these authors beats regularly, in rhythm and with rubby vigor. They are forthright in their explicit directions concerning the ministry of prayer and the Word of the Scriptures. In this sense they bring into contemporary utterance the earlier wisdom of Cabot and Dicks in their classic book, The Art of Ministering to the Sick.
The authors of The Hospital Handbook have demonstrated that the hospital is a community. Your own sense of what a community is will be informed richly as to the nature and composition, stresses and strains of a community like a hospital. Furthermore, they give guidance as to how the pastor can multiply his or her effectiveness when he or she becomes personally and not just anonymously related to the members of this hospital community. Many references are made to physicians, nurses, and others who are members of both the hospital community and the church community of which one may be the pastor. In the last chapter they move the two communities into even closer relationship with each other. They give specific guidance for selecting, motivating, and educating lay persons in the church also to participate effectively in the care of the sick. Thus both pastor and chaplain become facilitators of the expression of the gifts of lay persons in their ministry to the sick. Moreover, they become catalysts of community at both places—the hospital and the church. Underneath these strategies of Reimer and Wagner is and implicit if not explicit appreciation of a systems approach to both hospital and church, both patient and family, both medicine and ministry.
A point of unusual concern in this book is its emphasis upon the pastoral care of the sick child and his or her family. One of the most profound passages in the book for me is as follows:
All gifts and skills of the ministry come to focus in the experience of a child seriously ill. Perhaps no other life event renders persons so vulnerable. Deep within us there is a primitive if not profound notion that everyone should have a past. Any threats to a child's accruing a past become symbols of how unfair life can be and how injustice is woven throughout the fabric of creation. Parents and other adults experience threats to the child as a feeling of having lost their future, their immortality. Offering faith in God must be done in the face of these realities, not as a means to remove them. Having an adult faith means affirming life despite the world being