End of Life – Reflections from a Spiritual Health Practitioner

“Coming to Rest,” Michael Swan, https://flic.kr/p/2iqfLsS

A nurse asked me a question during my first unit of Clinical Pastoral Education at the Ottawa Civic Hospital 19 years ago. The question involved her expectations that chaplains provide primarily religious support to patients. This expectation often surrounds this job. I knew it then, and the intervening years have only reinforced my certainty that the agenda of a chaplain is simple and straightforward: to listen, to be present, and to connect with someone soul-to-soul.

Chaplains hope to empower patients to heal old wounds, forgive, find peace, and feel worthy to be loved as they are. Being loved and accepted despite our dark sides, regrets, and fears is a life long journey for all of us. However, this journey intensifies at the end of life. The role of the spiritual health practitioner, then, is to act as the agent of love and acceptance under the most difficult circumstances possible.

Over the past 19 years, I have witnessed people die both suddenly and slowly. I have watched the passing of those who expected their end due to terminal illness, and those who planned it through MAID (Medical Assistance in Dying). I have heard many people confess their regrets, reveal their brokenness, and express their hopes. I have witnessed the great inner strength people have developed through relationships, spiritual practices, self-awareness, and humility.

However, grief and pain are not limited to those rooms in those moments alone; grief and pain are present before, during, and long after the death of a loved one. It is in light of this limitation that I reflect on my 19 years of service and ask myself where we, as a community, can enhance our support. I consider whether there are enough places for people to sit and reflect on life and faith. I contemplate whether there are enough people to listen, support, and accept those in mourning. As a result of this introspection, I feel confident making the following suggestions.

Support for Family Caregivers
A prolonged period of caregiving may lead to feelings of isolation and loneliness. Caregiving causes emotional and vicarious trauma and inevitably takes a huge physical toll on the body. These feelings are even more profound for caregivers when accompanied by the realization that they are burning out and may have to admit their loved one to a hospice or a long term care facility. I have witnessed caregivers suddenly showing up in the hospital because of stroke, heart attack, or falls. All of that stress accumulates over time and, when combined with grief, the body simply breaks down under the weight of it.

Offering these caregivers respite from their task, even going out for a simple cup of coffee and a talk, has immense benefits. These opportunities can happen during the time of illness as well as after to help deal with the grief and loss. They can be created by friends and family, or could be arranged by a community-based organization.

Bereavement Support
In my current position as a spiritual health practitioner, I provide in-house bereavement support to residents and patients. For example, a patient who is terminal will likely need support in dealing with their grief. Practices, such as a Life Review or Dignity Therapy, are suggested. These are designed to assist the dying with reflecting on their life story.

Spiritual health practitioners are also able to provide bereavement support to the family and friends of the person who is suffering. I have shed many tears while saying an end of life prayer, listening to lovely reminiscences, and feeling the pain of past hurts and regrets. I know my presence there at that moment can offer peace and solace to those who seek it. However, after the end of someone’s life, the follow-up to this type of hands-on care is very limited.

People can locate The Canadian Virtual Hospice. This site includes a link to MyGrief.ca, which consists of a number of videos by bereaved volunteers who share their story. Hearing the stories of others can give people who are suffering some comfort that they are not alone in their pain.

Some churches have taken on the task of running bereavement support groups, and there are numerous provincial hospice and palliative care associations that strive to support grieving people over the longer term.

For some, these sorts of care are enough. However, some people may require more individual support and might even require professional counselling. For individuals, gaining access to this kind of resource remains quite challenging.

Educational Opportunities
There are some materials, such as Dr. Alan Wolfelt’s 100 Things to do While Grieving the Death of a Spouse, available to those individuals suffering after a loss. The internet also represents a number of opportunities for people to seek out supports. Workshops are periodically advertised on many web sites centred on grief and loss. Organized events, such as Death Cafes, can bring one’s community together to discuss various end-of-life and bereavement topics.

Spiritual Opportunities
Churches also offer a number of opportunities for the bereaved to come together and grieve. For instance, Blue Christmas services are a way to recognize that holidays can be hard. The loss of parents is observed on Mother’s and Father’s Days. Many churches also offer a service for those traumatized by the loss of a child through disease, accident, crime, or miscarriage. All people grieve, and it is this pain that unites us despite where we are from or where we worship. The question is: do we as a community give sufficient sacred space for grief and mourning after the ceremony has ended, and are these services open to all?

The biblical story that always challenges me to reflect on the work I do is the story of the woman at the well. Jesus, thirsty from his travels, asks a woman for water from the well. It is a simple request that is made complex because of her “otherness” – being not of his nation. Christ was present, patient, accepting, and he listened to her story. She told her story to him because she felt safe that she would not be judged, ignored, or dismissed. This is the goal I keep in mind in all my visits. We are called to be Christ-like in our approach to all people, and I can only hope to continue to strive to reach this goal.

To sum up 19 years of my experience as a spiritual health practitioner is a challenge. However, upon reflection I realize it is an honour to serve, to be a keeper of stories, a companion to people at the end of their journey, and to recognize my own place in that shared journey. I have begun to reflect on my own life story, my own joys, my own hurts, and my relationships with others. I can only hope that when I come to the end of my journey, there will be someone there to see me through it with a listening and accepting heart, and to support my loved ones through their loss in the days and years that follow.

Helen Holbrook has been a spiritual care provider for 19 years. Currently, she works at the Riverview Health Centre in Winnipeg.

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