Chapter Five- Helping Families Cope with Bereavement

Whenever a family member dies, there is a process that a healthy family undergoes in response to the loss of one of their own. After the death of one of the family members the family needs to get itself back into the rhythm and balance that was lost when the family member died. When we consider bereavement, we usually think in terms of separate individual grief, rather than thinking of it as a thing for the whole family. When someone dies a whole family has lost someone. Many times families are not aware of what they are doing. During the loss of a family member, individuals mourn differently depending on who has lost whom. The death of a spouse will alter in some way the survivor’s relationship. On the one hand children lose so much when siblings die. When they lose their brother or sister, they lose their family as they know it. The loss is profound. Brothers and sisters share a special bond. On the other hand, death of a parent is one of the most difficult experiences of lifetime. For children left behind after the death of a
parent, it shifts responsibilities onto their own shoulders. And as we shall see in this chapter, the death of a child is an ordeal so traumatic that for many parents, it is profoundly painful. It throws many parents off balance.

Whether it comes suddenly or slowly, early or late, violently or serenely, the death of a loved one changes one’s world in a way that nothing else can. In a family setting the mourning families often have difficulty finding any of their own to validate each other’s feelings. At a bereavement meeting, we met a woman who was grieving the death of her mother. One day she made a mistake of crying in front of her sister. “What’s wrong with you?” her sister asked. Mourning does not have a timetable and individuals can mourn and grief for different lengths of time. One’s response, however, of the death of a parent will of course be influenced by a number of factors. The young woman in this case might have had strong relationship with her mother; for that reason she mourned the longest. According to Rando, the importance of the loss will be determined by the meaning of the relationship and the roles the parent played in one’s life at the time of death (1988, 137). These include the loss related to social expectations of the parent – the social roles and functions that the diseased played and expect to play in the future in his or her family, and in society at large, in addition to the simple unexpectedness of someone young dying before the older one (Kagan1998, 130). With all these complexities of the family, how do
we help the entire family deal with bereavement?

When a member of a family is dead, the whole family suffers the same profound loss at the same time. Acute grief disables all in the family. But, though particular styles of response are different, all are undone. Grief cuts all the family members at the knees, drains and depletes all. No one has power left to help the other. In the same family, one can see the other sinking, but no one is there to help for it is like all are drowning and none can help. Rosof points out that, “how one deals with loss of a family member is influenced by gender and the family that one grew into” (1994, 93). Men deal with grief different than woman.

Whatever the case may be, there is nothing like a good death in the family to bring out the best in humans. Thus, when there is a death in the family, the family needs to be looked after. Their emotional needs- needs to be taken care of; attention to them as mourners needs to be addressed. Many families at the time of loss want to feel noticed, protected, loved, and even are surprised by how caring people can be in terms of help. They need to receive flowers from friends, and neighbors. They need hugs of love and comfort. On many occasions they need many, they need thoughts to support them in planning for the funeral and after. Even those families that neither seek nor desire outside assistance find solace and strength when it is offered. according to Lightner, the majority of the help is offered in the beginning. Immediately after the death and for a few weeks following the funeral, friends can be exceptionally sensitive and giving. Flowers, food, phone calls, fond reminiscences, and, above all the mere presence of other people
are profoundly consoling. They convey the message that others recognize the depth of the loss, understand how difficult the adjustment is and want to help. This is something mourners are grateful to receive (Lighter 1990, 40).

When the whole family is in bereavement, it is a needy time. As mourners they are vulnerable in the extreme. Many things need to be done in the family, and yet the world has crashed on them. By the death of a loved one in the family, everything in life has been shattered. It is at this time that the family requires someone to call them and acknowledge the death of their loved one. Although they are individuals alone in their grief, personally affected, talking and sharing, and allowing other people inside their hearts as they mourn and grief, can lessen pain. Calling, and dropping by, are some of the ways that help can be given to family member at the time of loss. Tokens or flowers or cards pack have a lot of meaning to the bereaved family. One does not need to say much. An other important thing to do during bereavement is sharing. As Anders contends, families and friends who stay open, sharing their feelings whether hot or cold, trust each other more readily and survive losses with less guilt or ambivalence than families living with barriers (Sanders 1992, 203). Lightner agrees with Sanders when she points out that most mourners supremely touched when friends share stories about the deceased with them (Lightner1990, 46). Grief shared is grief diminished.

What most mourners seek is an indication that they will live through this sorrow, and that other people understand and sympathize. We need to know that as friends to those mourning, about whom we really care, there are easy ways to show them that we love them. We need to provide practical help. One can offer to go to the dry cleaner’s or wash the car. Bringing food is a custom that still serves today. It should be encouraged for the bereaved family will not have time to cook for themselves and the visitors coming to the family. Offering to cook food and bring it to the family is positive support. Attending the funeral service counts. It is support to the family. Many mourners have been incalculably moved by large turned at the funeral day. It makes a difference to the mourner to know that other people share their grief. And it is good to know that one’s loved one affected the lives of so many others. One can walk, share meals, or help the mourner clean out the garage. One’s presence matters. Many bereaved people spend a great deal of time alone; they dwell in grief, fear, and despair. During those empty hours and days, nothing is more soothing than the presence of an understanding friend. However, some people may want to be alone for them to process what is going on in their lives. Or they may wish to be speared the necessary of talk. One can continue to call weeks and months after the death. That’s
when many people begin to disappear into the ether, and that’s often when contact is most appreciated. One should ask if there is anything to be done to help. “Or do you want to talk?” Sometimes by asking a question help in clarifying the need.

One should touch the mourner to keep connected. Sometimes just a pat on the shoulder, back or a hug is all that is needed. It means a lot because the person in mourning often is touch deprived. Widows and widowers certainly feel this deprivation, but so do people who lose children – especially if the are single parents. If one is a single mother, physical touch is so important. To have someone there to hug the mourner, to put an arm around the shoulders or to touch the mourner’s hand, is extremely comforting. As the touching continues, let the mourner speak. This time of holding and letting the mourner speak helps them vent what is inside of them. It may be frustrations, anger, hopelessness, depression, and they may be desperate. Actually sitting in the kitchen and listening to someone who is bereaved can be helpful. When someone you love is mourning, it is kindness to listen, even if you have heard the story before. If the mourner
brings up the subject of the deceased or the death, it is always advisable to listen without
changing the topic even though it may churn up a lot of feelings. It may mean tears and lamentation, anguish, guilt, and inconsolable sorrow.

One should let the family or individual mourning know that you are available at anytime they need you. You may leave you phone numbers with them so that when they need you, it will not be difficult for them to get in touch with you. This is because most mourners when left alone, and especially at the middle of the night, they feel the need of human contact. It has been observed that during mourning time most visitors who come to comfort the mourners ask specific questions about the deceased. Don’t barrage them with such questions, especially if they are not volunteering to share with you. Don’t criticize the mourners’ actions either. Don’t also impose your ideas about how long grief ought to last. Your role as far as grieving is concerned is to support. Clichés are not allowed as comments. Most people will, indeed, feel better as time goes by. Don’t say something like “You will get over this soon.” Don’t impose your spiritual beliefs on
people when they mourn.

One should not compare personal grief if one has had any with those that are grieving at the moment. Similarly do not diminish the grief a person is feeling by pointing out that things could be worse. One should not say that the bereaved should be grateful because the death was swift or the person was old. Age does not diminish grief. Do not say that other people have suffered more or that life is better where the deceased is. Comments like this only force the mourners, at the moment when they may be suffering the worst loss of their entire lives, to agree that things aren’t so bad. That may make one feel better. It makes them feel manipulated and unrecognized. Above all remember the reason for being around a person who is recently bereaved. If one can’t bear to be around a griever, he or she should send notes. The only one thing you need to remember is to be compassionate.

Looking at the future with positive thoughts is like closing a wound hence the process of healing. The scar may be visible and may be permanently there, but eventually the wound has healed. In the author’s community where was born and raised, in Africa, there are rituals and ceremonies that bring the bereaving person to a new beginning. Friends and neighbors meet at the family of the deceased after the funeral, and symbolically drive away the spirit of death in the family. In this case the ritual is to separate the living and the death and to give assurance to the living that they have to continue with life positively. This becomes a bridge to the future whereby the living are left to continue their lives with a new hope. The very fact that they begin to have thoughts of a future leads them to a fledgling feeling of hope. This marks the beginning of being able to look
back past the tragic events of the death to see the happy memories that the living had with the loved ones before death attacked. A more realistic view replaces the idealistic one that helps them through the earlier phases of bereavement. An idealistic view works very well for the bereaved when they need balance for their ambivalent feelings (Sanders 1992, 101). This brings about grace, comfort, and peace. It signals that the end is not here yet. Contentment about the past and hope for the future accompany acceptance. In author’s community as said earlier, the living have a strong sense of belief that they will reconnect with their loved ones already departed, “The living Dead.”[1] Sanders further points out that once we are able to finally think in these terms, we are ready to move on to the final stage of grief, that of renewal ( 1992, 101).

In his book, Transition, William Bridges says of new beginnings that we come to beginning only at the end. He writes, “it in is the ending and the time of fallow neutrality is finished that we can launch ourselves out new, changed and renewed by the destruction of the old life-phase and the journey through the nowhere” (1998, 19).We have discussed so far the different stages that people go through when they are faced with tragic news of the death of a loved one. Among them are anger, coping mechanism, and confusion. Kubler - Ross acknowledges that the one thing that usually persists through these stages is hope (Kubler 1969, 148). Hope builds transcendence[2] which most mourners need to the rebuild in order to restore their lives to “normalcy.” They find a new normalcy, one that has a greater quality. They are growing, and will continue to grow, beyond the person they were at the time of death. Moody points out that people who transcend beyond the death of their pain begin to feel elevated above their former selves. They become stronger, kinder to self and others, and more appreciative of life (Moody 2001, 134). The living should be responsible for their lives and destiny. After death of a loved one, we cannot in any way escape loneliness nor be totally free. After death the living are all alone anyway; thus they have to learn a certain amount of independence; otherwise they will be overwhelmed by fear and uncertainty when loneliness became the order of everyday. Whereas most survivors become better human beings, the area that causes most trouble for many mourners is lack of emotional

independence. They fear their own mortality, suffer from prolonged stress, or grief-prone personality types. In her book Surviving Grief, Sanders asserts, “We must eventually learn to focus on positive aspects of our newfound freedom. In the beginning of grief, this need is hard to see. Like everything else in the process of bereavement, it takes a long to come into focus. We usually have to confront our loneliness, meaninglessness, emptiness, guilt, and isolation to realize that we won’t be overcome by them. After the confrontation we become more stronger and freer.” (Sanders 1992, 107). Sascha in her poem adapted from “We need to Walk Alone” (1990) clearly explains how recovery can be sort:

And does the bitter grief
Keep you awake-
Look at it full
As you would look
Into avalanche
Sweeping your life away-
Look at the bitter grief
With conscious eyes,
As you looked on death.
And telling your brooding sorrow
Yea, you know - that death demands
Unwavering attention.
Do not avoid that truth
Your mind repeats, repeats -
And then there comes a truth
Beyond the truth …
(No, do not turn away)

Into your bitterness love finds a way

To give you comfort.

And yes, your heart will hear
The sun when night has ended.

Sascha

Whether one is healthier and happier or weaker and sicker and sadder depends on many things that we may not be able to discuss in this paper. But mostly the way one handles grief and does grief work determines how long the process is going to take. In other words, what one believe about recovering from grief will in large measure determine what one can reasonably expect. Rando says that in grieving work total recovery or resolution of mourning, in the sense of completely and permanently finishing it and never being troubled by some measure of loss, is a false goal and usually does not occur (Rando 1988). When the work of mourning is finished, the reality of death is accepted. And recovery would mean living with loss and adjusting to life accordingly.

Catherine Sanders (1992) gives action to take for a bright future:Don’t be afraid to continue talking about your beloved person, even though much time has now passed since the death. You have every right to include your memories as a healthy part of your new life.

Continue to maintain a health and physical fitness regimen, eating well and exercising. You will have more energy as you move out into a new world that, hopefully, will become a way of life.

Realize that you have changed. Don’t let others try to put you back into old roles, and be especially aware of your own susceptibility to reengaging them. This will take constant vigilance. When you fell guilty over something you feel you should do, be wary. This is first sign that pressure is being applied. Head it off quickly. Comb your consciousness for any unfinished business you may not have completed with the deceased. Now is the time to deal with it, either in a small or “homemade” ritual or by talking it over with a trusted friend. Don’t harbor
unfinished sequences inside yourself.
As you move into your new found identity, allow personal restrictions to ease. If you worry, feel a sense of freedom as you do it. Being outrageous is fun sometimes. Plan a ritual to end you grief whenever you feel ready. Instead of being anticlimactic after this length of time, it is most appropriate. Few rituals are offers for grief in the first place. Try to recount some of the gains that have come to you during you bereavement a new found friend, development of more compassion for others, a new skill or interest. Tallying the gains will help you to offset some of the negative memories. Accept that you feel lonely at times. Loneliness is part of the transition of grief. You will miss the roles you used to occupy and will long for things to be the same again. Acknowledge the loneliness until it passes.

[1] John S. Mbiti in his book African Philosophy describe the departed as living dead who will reunite with the living in the future. John Mbiti is an African Philosopher with strong believes of the life hereafter.
[2] Transcendence is a spiritual rebirth, which requires stepping in the deepest valley of sorrow.

Chapter Four- When the Curtain Closes

When death has occurred, often it is difficult to understand the behavior of the bereaved family. Most people cry all the time, others think deep about the dead person and sometimes feel sad. Others still become irritable on the anniversary of a loved one. Maria, whose husband died while she was only thirty-two years old, questioned her own sanity. We are left wondering why the dead have such a hold on the living. The person is gone yet, he or she is still very much a part of the living’s life. Psychologists have engaged themselves in the study of reaction to death. Elizabeth Kubler - Ross points out that the first stage can be denial. The act of denial means that individuals push the idea out of there head as absurd, ludicrous, something that cannot be happening to someone known to them. Denial she points out, needs to be bad. It may even free people to act (1977, 36). Many people function as if they are in a dream. Others go through certain motions, carried along by events. It may be necessary to deny a reality that one is not
ready to acknowledge. Denial, then, has its uses. It gives us time to readjust our thoughts.

Many people become preoccupied with everything that happened the last few days before death. They look for omens, small signs that fore show the death. Many still seek a way to make death part of a pattern. This allows many to restore some order to the world turned upside down. All these responses are perfectly in accord with the normal response of most people when they experience death.

After denial, many people find themselves in a state of depression. Nothing seems to work. The curtain has closed. Hope is gone. No longer can loved ones see him/her again. Depression persists. Many become detached from reality. According to Robert, depression can be based on real or imaginary concerns (1978, 46). When depression persists the mourner may seek professional counseling help. Depression though is a normal stage for the mourner

As discussed earlier in this chapter four, the bereaved persons have questions that may contain all the anger, rage, despair, and frustration that is contained in the secular “Why me? What will happen to me when life ends? What has my life meant?” Which may also be addressing the question of faith. These are inherently issues of the spirit, not issues for the biology or chemistry. Looking at the “why me” question, there is rage against God for allowing death to happen. Or there may be a strong sense of disappointment. The bereaved family or individual may feel that he or she has observed her/his religious life all her/his life and now she or he is abandoned and cheated of the reward she or he expected. Religion is often identified with adherence to a part-
icular set of institutionalized belief systems and for some it has suggestions of the super-
natural. Religion itself plays an important part in the lives of Americans. A Gallup government Census 2001) poll found that 95% of those surveyed believed in God; 68% indicate they were members of a religious institution, and 44% had attended in the past seven days. About 58% of those polled said religion was very important in life. It is at this time that pastoral care to the person or and family is necessary. Survivors have a strong need to search for meaning. They are trying to understand something they cannot understand. One should recognize and understand that their search is justified and necessary ( Kubler - Ross 1980, 154). We may need to ask, what is pastoral care?. Pastoral care is communication of the word of God/Creator or the Supreme. It springs from the living Word of God given to the church. Pastoral care means and is care for the souls of man. Therefore man is the object of pastoral care.

Spirituality is an expression of how the person relates to a larger whole that which an individual perceives as greater than him or herself. The nature of this transcendent purpose can be expressed in different way. It can be expressed through a religious tradition or, perhaps, through a regard for nature. For other persons it may be expressed through connection to the other human family itself or in some other way. Spirituality provides a source of meaning and understanding about the significant of being human. It address the question “Why am I here?” An expression of spirituality can occur without any specific religious belief. Death in most cases shatters conception of the world. Many people feel an insistent hunger for understanding. Why did this happen? By seeking explanations, whether practical o spiritual, we attempt to reduce the terror of loss and reach some inner resolution about it. The pastoral caregivers duty is to make sense of the world.

Buckman asserts, “to support a bereaving family or individuals in their spiritual understanding of death, various things should be put in consideration” (1988, 24). The pastor should decide if he/she is close enough to approach the topic. A person’s/ family’s feelings about religious beliefs are very important and intimate. A pastor or counselor should not open a discussion with the bereaved family about them unless he/she is close to them. Pastoral counselors should remember to be sensitive. They tread delicately as they handle the issue at hand (Death). One should try to decide if bad theology is doing harm to the bereaved family or individuals. This also requires sensitivity and a readiness to listen without leaping to premature judgment or condemnations. If the pastor cannot decide whether or not the family is being helped and supported by their religious beliefs then, he/she should get help. The patient may find a discussion with a chaplain, social worker, and psychotherapist helpful. The pastor should do not take the lead in what the discussion is all about. Honor the family choice. This is not time to impose one’s theology on others. If the family’s religious beliefs happen to differ from the pastors beliefs, as long as they work for them, he/she should honor and support them. Being there and listening is the role of a pastoral caregiver.

One should note that as the pastor gives pastoral support to the family, difference in religious beliefs may sometimes appear to be so fundamental and so divisive that communication is threatened. No religion has a monopoly on truth and morality or has all the answers to life’s questions. So when a family is dealing with death, the pastoral caregiver should be looking at the practical value of the family’s religion as they practice it. The most sincere compliment mourning families can receive is to be listened to without judgment. The pastoral caregiver should take time to be sensitive to the inner need. It makes no difference how often they tell the story, what their faith is, or how much it varies. It is in the involvement of replaying events – struggling to understand and accept within their frame of reference. The pastoral caregiver may not need to speak about faith, or God, but to just be present and listen. Kubler-Ross points out that once the
patient dies, she find it cruel and inappropriate to speak the love of God (1996, 156). Abraham in his book The Art of Listening with Love says, listening to others in a loving, attentive way can transform them and their relationships, and help the speaker to feel better understood (1998, 89).

During the intense last few weeks of life, the physician not only cares for the patient, but often for the spouse and other family. However, after the patient has died, the family continues to need contact from the physician and to a large scale other medical staff. A physician’s responsibility for the care of a patient does not end when the patient dies. There is one more responsibility, to help the bereaved family members. This, however, takes a lot of toll from the physician and his/her staff. Earl observes that “watching patients deteriorates and die in their prime is emotionally draining” (1992 75 ). Kubler – Ross echoes the same thoughts when she says that, “clergy have only recently regained some meaning, some entry, and some role. The clergy deserves a significant place not only in helping the dying patient but in serving as a resource to the patient’s family and, hopefully, to the physician or to other health professionals who are troubled by the burden placed on their shoulders” (1975 14). How then do we take care of the medical staff as they work in such a stressful surrounding? On the other hand, patients who suffer damage at the hands of their physicians often seek compensation through malpractice suits, and physicians and hospitals view such suits as perhaps the only outcomes to be earnestly avoided, than the errors from which they presumably arise. Defensive[1] medicine, in which physicians make treatment decisions not strictly on the basis of what is best for the patient but also in part on the basis of what, will establish the most defensible record of physician behavior.

The other important factor to consider is the common cause of patients or and relatives being dissatisfied with the medical care providers, gap in communication. communication sometimes just gets off on the wrong foot. Considering that the medical care team is expected to provide the best care, they are only part of the team. Patients and family need to make the medical care team understand the needs of the patients so that the right care can be administered.

The increasing cases of medical caregivers breakdown ( Lack of proper communication, because of emotional drain), the spiritual and emotional care that the clergy can provide may significantly affect how the medical team is adversary going to be effective. Spiritual caregivers not only work with patients but also with staff who need support. An objective spiritual team should be able to identify or foresee potential problems among the medical staff and act quickly. The emotional and spiritual needs of the teams need to be addressed by professionals in the area, it is important to remember that the medical caregivers will themselves require spiritual support. The ability of team members properly to minister over the long term may depend on how much they are cared for themselves.

Grief is something silent, like snowflakes falling on a dark winter’s night, but never peaceful or serene or pretty like the pure white snow. When grief is silent, the tears seem to turn to ice, like the snowflakes, before the reach they eyes. Bereavement is sometimes raging, like a monstrous thunderstorm with all its fury and bolts of lightning sticking the hearts of the bereaved family. Bereavement[2] is complex and many people are frightened by it, frightened by feeling it, frightened by seeing it in others (Lighter 1990, 205). It takes time to get over the death of a loved one. On bereavement Kagan points out that, “grief reactions are more introverted reactions, similar to bereavement. This is characterized by more extroverted reactions, similar to mourning” (1998, 91– 92). Bereavement refers to the general state of one who has suffered loss and includes both grief and mourning. Grieving therefore is the work of coming to terms with the fact with the fact that the loved is dead.

Immediately after the death of a loved one, especially if the death was unexpected, the bereaved cannot simply face the loss all alone. As discussed at the beginning of this chapter, many people have periods of denial. Offering bereavement support is a task that has to be done in order for the bereaved to be successful in adjusting to the loss. Readjusting to the new world without the loved one takes a great patience and much practice. It is achieved painfully step- by step, as one gradually continues to come to grips with that person not being in one’s life as he was before. However, recovery from bereavement can only be partial, never complete: Many things are lost, many things are changed for both better and worse they are never the same (Shuchter 1998, 298).Rando agrees with this view when he points out that, “If the person you lost was truly significant to you, grief is not usually resolved in the sense of being finished and completely settled forever” (1984, 225).

When a loved one is dead, the severing family will have to find a way to make up for what is lost through death (The love one).They either compensate in some way for what they have lost or their desire for what they wanted or needed, that now is unfulfilled. The bereaved must confront the reality of their loss and learn to cope successfully with the onslaught of feelings that naturally accompany loss. The bereaved must achieved some balance that allows them to experience their pain, sense of loss loneliness, fear, anger, guilt, and sadness. It is true that during the early weeks of one’s grief, when the realization of loss has come true, it is accompanied by painful emotions; the bereaved are usually in such a state of mental and emotional upheaval that questions of acceptance barely occur in them. As a result, the bereaved have to change emotional investment in the deceased and accommodate to the fact of not being there. It means that the emotional energy that one had invested in the deceased is readjusted to allow one to direct it towards others who can reciprocate it in an ongoing fashion for emotional satisfaction (Rando 1984, 230).

Psychologically, we are incapable of relinquishing all the bonds, connections, and ties that are a part of our most intimate relationships. While at the hospital as a chaplain, was called to give emotional support to a woman who had lost her husband of forty years. The first words that she said were, “how am I going to get along without him?” The bereaved person must be emotionally prepared to live with an altered relationship with the dead spouse. The woman in this case was not prepared emotionally. While many of the bereaved continue their relationships with family and friends in much the same way after their spouses’ death, it is difficult to imagine a situation where no change occurs (Shuchter 1986, 302). Learning to live alone or feeling alone after the death of a loved one is part of the process of death


There are a number of signs, which can signal that different people need professional help in their bereavement. This is always dependent upon the unique characteristics of the particular griever, the specific death and what it means to the griever and the social and Physical factors influencing the mourner’s grief. Ross Betsy, says that to help the grievers accomplish it is being willing to listen to their story over and over. We desperately need the help of friends in getting through bereavement. Human beings are not animals and they need the support of people who love them and accept ups and down. Bender contends that friends can help those who have lost a loved one simply by acknowledging the importance of their grief. Friends of the bereaved can offer support in a number of ways (Bender 1998 123). `

As with other aspects of bereavement and grief, the answer is extremely personal. Some people find solace in work or play; others seek out companions; still others withdraw for a while. Each of these responses to loss makes sense to some degree. We need companionship. We need solitude. Ultimately, we must return to the outside world and all its complex ways of involving us. Some people, on experiencing the confusion that often follows a death, seek counseling or therapy to help them deal with their situation. Unfortunately some people dismiss the possibility out of hand. However most people who seek therapy during bereavement are dealing with at least issue of death.

Therapy during the grief process serves much the same purposes as it does under other circumstances. It allows one to express emotions. It provides a place for clarifying problems and exploring possible solutions. Therapists have many methods of helping clients deal with bereavement. One-to- one is often helpful during the grief process. Our concern however is what is referred to bereavement group. Myers in his book When Parent Die calls them grief workshop, bereavement seminars, mourning clinics, (1986). Despite their numerous titles, these groups all provide some form of group therapy or consciousness-raising; some stress self-help and are a form of peer counseling. Most are organized groups. Candlelighters is a non profit organization with emphasis on promoting an emotional support system to each other (Donnelly 1984, 240).The bereavement group does in fact seem to provide the safe place in which those grieving want to participants in the group will find themselves able to feel and express what has seemed embarrassing or even forbidden elsewhere.

Just as hospice care often meets special needs of the dying, the bereavement support groups meet special needs of the bereaved. In addition, bereavement groups often serve a function beyond that of one-to-one therapy, to provide a sense of common experience and support among people going through substantial changes in their lives. If one has

been fortunate enough to know those who have had successful experiences in treatment in the past, a personal referral is always the best to have. Profession organizations, on the other hand, are the next option. Rando advise that family service agencies, hospitals, community service programs, mental health clinics, and college or university counseling centers are among other resources one could turn to for the name of professionals servicing a specific area (Rando 1988, 308).

These organizational structures by professionals are created to address the multiple levels of need as it is experienced by the bereaved. The group should meet once a week to share stories and listen to one another. Like many other support groups, this group should operate as a forum for examining bereaved experiences. The smaller the group the better for individuals, for they will feel free to speak or only listen. The small group will serve as an entry to the larger the organization. However, the focus of this group is to understand and cope with their experiences, and their efforts to provide support and reassurance to each other. According to Myers, “All we do is to create a safe place for people to express whatever they feel during their grief. We set it up so that people can responds in a way that will be helpful to them” (1986, 34). When such a group is set, the focus will be oriented to the emotional turmoil of the members. In the author’s parish ministry several years ago, he was part of a ministers’ team that had created a senior single mothers fellowship. The group met once a month to talk about issues that they face
as mothers caring for a family without the prospect of marrying. Members of this group showed great respect for the pain that each experienced as a single mother, and the need to talk about such feelings as sexual orientation were open. Like in bereavement group, themes initiated by one person’s internal stress were developed throughout the group. As a minister facilitator there is no problem of bringing people in the sport light by asking questions or asking them to contribute, they responded to each other positively. Shuchter points out that, “even in bereavement group, the therapist’s task is like that of a facilitator, although this task is frequently assumed by other members of the group” (1986, 330). Together the group came up with positive way of living right.

These groups can be wonderfully therapeutic in assisting each individual in them in mourning. They do not, however, replace in-depth professional assistance if is warranted, but they are uniquely supportive. They encourage, provide important information and accurate norms, and transmit advice, concrete guidance, and practical suggestions for dealing with bereavement. Schuchter observes that, “to be determined is the relative therapeutic efficacy of support groups in contrast to individual therapy for the bereaved” (1986, 332). When one is determined to deal with bereavement, Rando agrees with Schuchter by asserting that, “this can be quite helpful, since there are few sources of information in our society about how to be a mourner. Further he says that these groups can offer one the added benefits of opportunities to assist others. He further says, this helps one to break out of the passive victim’s role of bereavement. As a member of these groups one can get the unconditional acceptance and feelings of belonging that other members of the society may withhold the from the bereaved individual ” (1988, 311). See
Appendix 1.

[1] Treatment administered to the comfort of the patient.
[2] Bereavement is the state of being deprived after a love one’s death.

Chapter Three - Planning to die- Anticipatory pastoral care

The process of dying often takes a lot of time and most people know they are closing in on the end. Depending on what is causing death, many dying patients understand that they are ready to die. Recognizing that the end is near can be an enormous help to the process of dying and to the family too for the patient is ready to die. When the patient is ready it is important to focus on dying as a natural and inevitable part of living, no longer as something to fight. The greatest job of the dying should be to let go of all material and emotional grasping and to begin to experience relaxation and closure in whatever way one can. According to Dr. Tobin the process of acceptance involves an appreciation of the quality of life rather than the length of time it can be extended (1999).

It is advisable to discuss feelings with family and other pastoral caregivers. The loved one may have a lot of trouble with the fact that one of them is preparing to die. Most of the family may be denying the fact that a loved one is dying, and this demands a change of mind and continuing to fight to live. Family should give support when a loved one is ready to die. No loved one can prevent death; loved ones can only cause pain by hanging on to the one dying. Howard in his book, Facing Death supports this by pointing out that, “it is better to be able to be with patients in their pain, to support them without feeling the blind compulsive to rescue then as from something from which there was no rescue, and to stay with them as they approach death without feeling that one has somehow betrayed their trust”(1996, 35). The greatest gift one can give to a loved one or to a patient is to allow the awareness of ones own pain and loss to deepen solidarity with them as the face illness and death.

What is really the role of the pastor? What can a pastor do or say to the dying patients, and be present to the presence of God, give pastoral care even at the point of death? This means that the pastor as a pastoral caregiver has roles to play in medical crises, including at the time of death. He has to engage in the ministry of presence, truly being with the patient and those gathered around. Another role is the ministry of giving witness to the gospel. He may also play the role of an interpreter, helping the patient and the family understand health caregivers and vice verse. The moral role of the pastor therefore may entail more than helping patients as they make difficult decisions. This includes helping the dying and their families in their hope for a good health. The pastor is able to hear and call forth the deep stories, sometimes gently changing the subject from the preoccupation with the medical narrative to a deeper focus on the stories of the dying person and their family and how these stories fit within the timeless story of God’s life within them. Pastors can listen and encourage as the dying and their loved ones tell their stories and connect those stories with the larger story of faith, of what God has done for the world and what God has done for them. The dying bear witness to the ways that their life is an on - going spiritual quest for and with God.

What is the role of the pastor when dying is inevitable? The most difficult duty of the pastor is to comfort the family when a loved one has died. There is a terrible sense of despair. After the doctor announces the death of a loved one to the family, the next person usually summoned is the pastor for those who are Christians. The pastor is to be with the family to help in making arrangements, to contort, and to answer questions . If the pastor knows the family it would be easier for him to make arrangements and prepare for the funeral service. The pastor becomes a spiritual caregiver who receives the dying into the community that experiences death.

The pastor guides them through the chaos and the loss of the familiar, attends them in living through losses that can either be explained or replaced, listens through questions that cannot be resolved. The pastor, on the other hand, helps in preparing for the care teams from the entire church community. These care teams will help the mourners process their grief together in support to each other. The pastor will arrange for prayers to be said, and there are many acts of ordinary gifts that the pastor should encourage. In the midst of dying, the pastoral caregiver (pastor) should find moments for healing and sustaining, guiding and reconciling, nurturing and educating and modeling death as a normal event, offering benevolent and companionship. It is the role of the pastor to educate participants that life and death, joy and grief, hope and despair belong in the same theological sentence and understanding of God. Death is a guaranteed part of all human beings. The deaths of loved ones, as well as our own death. is a must. The question is not whether human beings face death or not, but rather, how they face it. Despite the fact that death is an inevitable experience for everyone, many dying people react with avoidance and strong feelings of fear and sadness. Few people have learned to develop a facility for talking about death, or talking with the dying. As seen in chapter one, grieving begins soon after the news of a terminal illness and continues long after death. Talking with the dying person should begin at this time when news has been given of the impending death. One may have only a week, months or years to say all that there is to the dying person. But it is necessary to be aware that their life is now time limited, and your relationship with them should give time to interact differently. Saying goodbye in words and in action helps clarify ones feelings about what a particular relationship has meant to a loved one (Wogrin 2001, 2).

Dying is much more than a medical event. It is a time for exchanging love, for reconciliation and
transformation for all involved. It is a chance for the dying person’s loved ones to become compassionate companions on a journey of continuous discovery. Dialogue does not only occur in words. The exchange of meaning can happen through presence, gestures, silent companionship, or touch. This means that the dying are not alone, have not been abandoned, or have not been isolated. It means that the dying have company through their experience. Presence is keeping company with another, as in raising children or sharing in family, friendship, and vocational relationships. This time is a time-sharing in the lifelong and inexorable movement toward the process and acts of dying and death. It is not only logic that one need an ending to relationship that takes place between the dying and the other person, Wogrin says that, “when you don’t take the opportunity to say goodbye you will be likely be left with the challenge to working
through a relationship process entirely on your own, which is a difficult task” (2001, 3). The presence thus is a way of saying, I will absorb your pain and horror. I will not turn from your suffering, I will not mute your laments, I will go gentle with you and wait in peace and silence, I will attend this human process as you enter it and, in a variety of ways, quietly shout of God’s presence.

Being able to join and support people in their final phase of life, and talk with them about what their life has been, who they have been, and how they will ever be remembered is of vital importance in working through the process. This joining and sharing will take different forms in different relationships, depending on the personalities involved. At some point, presence may yield to word (which of course, being grounding the understanding of Presence). A participant may want to know what you think. You will seek prayer and scriptural resources to use at the bedside, in conversation with family members. The dying person may want to talk about what is happening, the feelings concerns and fears. An early problem in pastoral care was the over eagerness for the care- giver to speak, to interpret, to pronounce, to state the theological or scientific point of view as to how the person(s) should be feeling. Wogrin asserts that, “speaking
about feeling makes them much clearer” (2001, 14).

Sometime when people are dying, they are determined to avoid all discussion of death. They may be too caught up in anger, so determined not to die, or so fearful of their own feelings that they won’t get near themselves, let alone allow anyone else near these tender feelings. When saying goodbye it is always good to talk about death, focusing all the energy on talking about the dying person’s life. There is a fine line between encouraging someone to get about and do something pleasurable to help enrich his daily experiences or improve his overall mood, and pushing him or her to do things he or she is not really up to doing. Talking to the dying person in regard to what he or she is feeling is vital. “How are you feeling today?” What is your energy level?” Encourage the person to pay attention to the messages he is getting from his body. Roberts puts it, “the gift to the dying person is an opportunity to fully say goodbye if the patient and the family do not escape into denial. Accepting the painful truth of impending death will allow time to say goodbye in person, in writing, by phone, on video camera” (2002, 63).

At the end of this chapter, the writer discuses how families and individuals react to the death of a loved one. The writer focuses on how grief comes in and later in chapter four outlines way to deal with the grieving family. The death of a loved one breaks a kind of dam within the mind and almost at once. There is a flood of memories, images, incidents, bit of conversation, shapeless feelings, and sometimes-even hallucinations rush forth (Myers 1986, 143). Some people feel a particular intense sadness or revulsion as the memory of their loved one. For others the hardest memories are like death itself. Grief comes in which is hard to bear. It feels as if one will never be whole again. There’s been death. It is someone you loved. You are frightened, confused, angry, distraught, numb, shocked, and dazed you feel helpless, and you feel powerless (Shaw 1990, 1). The permanence of death and the finality of the loss can leave one feeling as if one can never be happy again. The memories, pictures, and perhaps some belongings are all left, which may bring more pain than comfort.

Death as life crises pushes individuals into separateness which burdens family left the more. There are things one can do to help through the impossible aftermath of death of a loved one. Shaw recommends that within the first twenty-four hours to forty-eight hours following a trauma, one should engage in periods of strenuous physical exercise to ease some of the symptoms. Keep busy all the time, to help to body, mind and spirit to be preoccupied. Don’t label one crazy. Scream if you feel the need. Make as many daily decisions as possible that will give you a feeling of control. If someone asks what you what to eat answer him or her. Make a decision even if you don’t know what you what and don’t think you can eat. Keep talking (Shaw 1990, 1-2). Many individuals after losing their loved ones loose their identity too. After losing her husband, Mary (name has been change to conceal identity) says, “I didn’t know who I am anymore, in my family as an individual.” Later, when she tried to label and quantify what she’d lost when William died, she found herself sketching stick figures with limbs missing. Williams’s death had left her feeling like an emotional and psychological amputee. She had adapted to live without him.

Many people feel the unsettling nature of the loss. DeVita observes that, “the identity crisis that comes with the loss of a loved one doesn’t always lead to growth” ( 2004, 115). Almost every emotion can be part of grief. what makes these emotions hard to handle, though, is their unusual intensity. Almost every person in the crisis of death of a loved one, experiences emotions that are not common or that seem strange in the context of the loss. Acute grief usually includes painful yearning for the deceased one. There is excruciating loneliness for the person who died and for the unique relationship that has been lost.

Chapter Two- Dealing with terminal illness

Those who are terminally ill are confronted with painful and difficult choices. according to Mary E. Williams, “they must make decisions about potentially life prolonging treatments, expensive medicines, experimental therapies, legal questions concerning life support and the right to die, and issues affecting their family and loved ones” (2001, 16). There is also the limitation of medical technology and the complicated issues of illnesses, beliefs, and family differences among others. The society is not prepared to deal with the issue of terminal illness, thus it is uncertain as to how aggressive the treatment should be, uncertain as to how best to approach the patient. How then should those at the verge of death be handled?


As will be seen later in this chapter, the hospice industry in the United States and maybe in other countries as well, actively seeks to provide competent care to the terminally ill. The desire to put these people into categories leads to depersonalization. The challenge to care for those with terminal illness is obvious in today’s culture. It is complex, especially when presented with the issue of talking about end of life. The cultural, historical, and theological viewpoint of the individual patient, when assisting them and their family in making or rejecting the choices they have made is paramount. Most families would want to go by the wish of the patient as expressed to them.

However, it also depends on the religious believe of the patient. This in itself become so complex if the patient and family argue on the basis of what they belief. Let us consider some religious beliefs that may lead to complexities of caring for the terminally ill. Terminal dehydration[1] has particular aversion for the Jewish population because of the the Jews view of life and food as of a life sustaining, healing, and comforting agent.The fine line between what is life sustaining verse what is death prolonging and the conflicting viewpoints with the various Jewish sects. Food is closely associated with the value of life for most Jews. The Jews believe it is a duty to live at all costs. The dilemma of withdrawing food and fluids becomes tied into the limited time frame of three days before the death to say that one is a dying person. Thus at this point many Jews have mistrust of the caregivers in the United States, for example. For Jews, perceiving hospice
as a “Christian” movement might bring the thoughts of fear, abandonment and desecration of the body. Fear is because of the past experiences with anti Semitism, abandonment is because the Jewish patient and family might not be aware that hospice death is with dignity (Bairds 2001, 209). Having said this then, notice that there exists a problem since care will not be as effective as the hospice may want.


As difficult as taking care of the terminally ill would be, it is also very difficult to understand the job. In the final hours of dying, the dying person makes demands, gestures and speeches that seem to make no sense. Family members, nurses, doctors, and other caregivers may not understand. As a result they respond with frustrations or with annoyance. They may try to humor the patient or to stop the confusion with medication. Gallanan assert that, “this is done to distance the dying person from those they trust in producing a sense of isolation and bewilderment.” (1992, 22). Keeping open minds and listening carefully to dying people is the only way to understand them. Therefore, when they are understood, they participate more fully in the event of dying. Families and friends can gain comfort, as well as understanding what the experience of dying is and what is needed to achieve a peaceful death. With the above viewpoint, then we would say the manner of dying benefit the dying person and the family. The dying need a healthy care philosophy and practice that attends to the physical, psychological, and spiritual needs of the dying. Caregivers should focus on alleviating the physical pain of terminal illness.
They also should help individuals face an impending death and achieve a psychological closure of life. The value of assistance for the dying, Williams the author of Terminal Illness: Opposing Views, points out, “has been largely ignored by the mainstream medical community”(1992, 22).


In this baby boomers age, more family members are providing care for aging parents and relatives. Theses family caregivers are the cornerstones of the long-term care system, providing millions of hours of unpaid services. This assistance runs the gamut from running the occasional errand, such as shopping or picking up medications, to providing significant amount of personal nursing care. Care giving can be gratifying and meaningful, but at the same time, the ongoing responsibilities take a toll on many caregivers’ physical, mental and economic health. Caregivers of these patients are more likely to have depression, a risk factor for many serious health conditions. Policy- makers have to recognize the effect that this trend will have on coming generations. A recent national survey by the National Family Caregivers Association (NFCA) found that more than one quarter (27%) of the adult population has provided informal[2] care for a chronically ill, disabled or aged family member or friend during the past year. That
represents more than 54 million caregivers based on current census data.

Terminal illness care, is an area that even professionals don’t understand too much. Braid compares terminal care as a game with which even doctors are unfamiliar. Rescuing a patient whose condition is unstable is a serious game that we are quite uncomfortable playing (2003, 48). Without a clear understanding of the object (which is to save the life of the patient) of the game or its rules, patients’ care at the end of life is subject to dangerous inconsistency. Coping with terminal illness is more than hard work. It is all consuming and creeps into every corner of people’s life. There are so many people to talk to, so many questions to ask, so much to do. Terminal illness does not only belong to the one who is sick; it affects family members, friends, neighbors, and coworkers too. Each person involved had his or her own set of issues, questions and fears.


As seen in chapter one, people react in many ways to news about the impending death of someone they love or that of their own. They may feel shocked, disbelief, hunger, or fear. Fear of death is so common in all societies. As will seen in this chapter, fear of dying is not one fear but a multiple of fears. Thus, the author has called other fears that follow concerns. There are concerns to do with physical illness and incapacity, concerns of being handicapped, concerns of being a burden on friends and family, and concerns of being unable to contribute to the well being of the family. There are concerns about physical pain, concerns about the ending of life itself, and concerns of dying while some of life’s potential is unfulfilled.

As Buckman observes, “the precise nature of fears and concerns will partly depend on the nature of the relationship of the person dying to the living and /or the nature of one's own (1988,62). Fear is dealing with the unknown. For the loved ones may be frightened of being left alone, of being helpless, of cracking up and failing to cope, of being a hindrance to the dying person when one should be a help, of trying to live without the loved one afterwards and failing, among other fears. Why is fear the dominant factor during dying moments? Murphy points out that, “this is because it has not been easy to say what we need in our family, and to say it without judgments”(1999, 106). When fear dominates, one should focus on what is precisely bringing about the fear. Assemble the list of things that bring fear most, and observe that fears are as a result of the undone things with the dying loved one. Therefore, there needs to be a time for family to come together and discuss feelings, and share what their feelings are. But to most people this is unthinkable. In most cases the idea would be rejected by most of the family. But when stories are told, the dying has the opportunity to die in peace and leave the family in more peace. Assisting the dying, giving time and space to ventilate what is in his or he mind, and staying close while this bring relief to the patient. How soon can this fear of dying be overcome? The answer depends on how fast the individual is able to cope with the realities of death. The fear of living incompetent life must be overcome. Death is a threat largely because it eliminates the opportunity to achieve goals important to our self-esteem, or because it deprives one of a chance to have longed-for experience. Death fear, like anxiety in general, is invariably related to a situation that has not arisen. It is, not an actual one (Shepherd 1975, 124).


Anger at some stage of an illness is very common. Why do people get angry when they are ill? It is actually common in any illness, whether serious or not, even with a simple and self-limiting illness. The single most important reason is loss of control. Most dying patients try hard to have control over most of the things that happen in their lives. At this time it is necessary to reflect on anger as described earlier, that dying people might feel angry. It is not uncommon to hear someone terminally ill ask, “Why is it happening to me?” Some people feel angry with God for allowing them to be sick, other feel angry at their doctors for not being able to find a cure, others still feel angry at the government for putting money into weapons instead of medical research. Rather it is much easier emotionally to find fault with an outside force than to accept death with
calmness (Angel 1987, 79).

If a family member dies unexpectedly, or too young, or as the result of an illness that might have been cured if detected earlier, it is normal for the surviving family members to feel angry. They may vent their anger towards the medical staff that cared for the loved one already dead. Sometimes these feelings have no basis and sometimes lawsuits follow. Other times they are never justified at all. Yet the loved ones are distraught, and use anger as emotional outlet. It is uncommon for loved ones to turn anger unto themselves. This manifests itself as guilt. (Angel 1987, 97). In authors experience as hospital chaplain, he has dealt with many individuals who are angry, over the death of their loved ones, or their own death. One afternoon the was responding to a unit emergency call, only to learn that a patient had died; thus he needed to help the family with emotional and spiritual needs. Family members were all on the hallway shouting, screaming, and running up and down the hallway. One of them said to me that their mum was doing well five minutes ago and she (one of the daughters to the patient) does not know what they have done with her, and they must “fix my mother." This daughter felt angry that the
mother had died and they have not done anything about it. Therefore, the anger was directed to the care - giving team. Kubler -Ross in her book, On Death and Dying indicates that, “when the first stage of denial cannot be maintained any longer, it is replaced by feelings of anger, rage, envy, and resentment” (1969, 88). This stage of anger is very difficult to cope with from the point of view of the family and staff. The reason for this is that this anger is displaced in all directions and projected onto the environment at times almost at random.


The uncertainty about death brings about many unanswered questions to the dying or the family. Immersed in all sorts of feelings, they wonder, whether to talk about it or not, or ever accept the reality of dying. Thus since the above has not been solved in the mind of the dying or the family, death becomes remote, no longer an integral part of life. The problem for most families dealing with death is that it is not easy to say what they need to say in the family setting, and say it without interruptions or judgments. Anything of a painful nature that might cause feelings to be hurt is not disclosed. In this kind of scenario, the family cocoon is not permeable; tears and feelings of all sorts are not allowed to mix with the family dynamics and catalyze healing, with the residue flowing out so that the family within is softened and nurtured (Murphy 1999, 106). The anxiety raised by the question of dying might also induce rage, with an angry demand as to why the dying person is trying to be upsetting. Those in this state move on further, past the tears and anxiety and anger, and probably would say that they would not want their death to be a burden to the family and that they need to get on their own lives as if death was not part of their own life.

Dealing with death and dying

Persons who help dying patients round out their lives expend tremendous energy. This needs replenishing. Patients and friends help in replenishment, but since they come and go, there is need to recognize the importance of ongoing relationship of the Hospice. Little wonder that in the process of dying, when there is often much tension and grief, patient and family feel quite unable to navigate alone and yet may not find the appropriate guidance from their physician or other caregivers. Thinking about death, dying, bereavement, establishes a ministry. Caregivers[3], which mean everyone who attends to the dying, need preparation to care for the dying. According to Murphy, “at the end of life, when all is said and done, the family members who are attending their dying relative as both guides and witness will often encourage their loved one to let go” (1999, 140). Holding on to one another for dear life in bonding dependency is a way of life in many families but this makes it painfully difficult to die. Families not only have to deal with the pain of knowing that a loved one is dying, but they do so in a state of uncertainty, not sure of what to do, how to do it or when. On the other hand death comes too soon sometimes with no time for process of the dying. This can be devastating to the surviving members or the family and all others in social family. Very few health people actually want to die, and very few seriously ill people actually hasten their deaths. We are all programmed to hold on to life for as long as possible. This means that if somebody tells us he or she has an illness that may kill, we find it very difficult to accept it as a fact. Everybody facing the threat of death has to make a painful transition from thinking of himself as a perfectly healthy person to thinking of himself as somebody who might die. One can think of this transition as going from “ It won’t happen to me, to, it really might happen to me.” (Buckman 1988, 29). How can we face the prospect of our own deaths and the deaths of others that we love? In her book Talking About Death Won’t Kill you, Virginia Morris writes,“Death belongs to the dying and those who love them” (2001). Usually it shouldn't. While we know that death happens, we don’t quite believe that it will happen to us, or to those we love, even when we think it will, not in the near future. Many people do not have any vision of what they would do if happen to them. Death has become unfamiliar territory where there is so much more we need to know about it.


In an article in the, Journal of Psychosomatic Research (2000) entitled “Facing death” Hinton cited one study at a tumor clinic where 560 patients were asked whether they would like to know of a fatal diagnosis: 80% desired this information, while 12 % didn’t. The remaining 8% would not give a response. Why do we find this kind of variation? Sharing news of impending death would create too much stress that the patient cannot handle. In fact, even doctors and other medical caregivers cannot handle the death of a patient. This is because many caregivers are not prepared to deal with death and dying. Elizabeth - Kubler Ross, who has worked with over nine hundred dying patients reports that, only 1% are prepared for death (1988, 34). On the same note Shepherd asserts that “people get born and they have to be prepared to die one day” (1975, 35).
During the period author has been hospital chaplain, he come across people who are prepared to die and very much at peace. He also had families and loved ones who found that caring for the dying person, though very difficult, was a rich and gratifying experience that changed their lives. In his book, “When Someone you love is dying” Shepherd observes that, “it is as unrealistic and damaging as denying that time is running out. We can receive comfort, then, in knowing that nearly everyone who has been given the news of incurable illness manages to put to some Creative use.” (1975, 48). This includes the survivors as well. Albom, in his book, “Tuesdays with Morrie” points out that “to know you are going to die and to be prepared for it anytime, that’s better. That way you can actually be more involved in your life while you are living”(1997, 81).


Another difficult aspect of dying is dealing with emotional toll. When the author first became a resident chaplain in one of the leading hospitals in Houston, Texas, he could not understand why every evening after work I got home feeling too tired and worn out. When a patient is dying, all caregivers take the toll of not able to “help” not die. For the patients too, psychological pain is difficult to measure or study. Pain at death is prolonged with a lot of loneliness and frightening. Most disturbing of all is that patients who are dying are typically distanced, both physically and emotionally, from loved ones, who can’t hurdle the physical intrusion of the hospital and who often don’t have any idea of how to help or what to do. They feel powerless and frightened in the face of death. Williams contends, “terminally ill patients should plan for the end of life. Asserting that planning near the end of life is helpful. By thinking ahead about what could happen, and
How one will deal with problems if they do, one can create a better life and a better quality of life for oneself and the people who love and care about you” (2001, 67).

Dying brings with it dramatic physical changes that the dying person, the family and caregivers must anticipate. Some patients will lose the ability to walk, and care for themselves. Most times dying patients will use diapers and bedpans. Family, friends, and caregivers must be prepared to deal with unpleasant sights and odors, especially if a loved one is dying at home. There are physical changes that occur when danger arises, “Fight and Flight.”[4] This happens when there is death and with the subsequent sadness and grief that is experienced with all the changes that occur. There are the physical sensations of grief and they are just as real as the deep heartache of emotional grief. When death is near occurred, many dying patients and grieving family members are struggling with resisting the natural reaction to change. There are so many losses that a dying person deals with, some of which we will not be able to deal with in these hort pages.
Human beings are relational beings attaching themselves to people and things that are, at the same time finite. This combination of attachment and finitude[5] is the occasion for grief. The fundamental human dilemma is that human beings are limited creatures who know that they will die. And the fundamental human longing is that we might keep the unity we had before birth forever. Herbert Anderson in an article entitled, “Moments of Loss, Seasons of Grief” points out that, “When our job, primary relationship, or vacation is pleasurable, we like to think it will never end. Therefore it is not surprising that we struggle with being finite creatures”(Circuit Rider 2005, 21). Even when we believe that death is part of God’s plan, we will rage at death when it is experienced as a thief that robs us of people we love. Every human being is attached to things or relationships which form strong bonds of affection. Some people however will seekLimited attachments because it is too painful to lose what we love. Some kinds of Christian
spirituality support the conviction that we should limit our attachment because this world is not ours, we are but sojourners.

Understanding the pervasiveness of loss gives us the opportunities for learning how to grieve and prepare for death from the beginning of life. Kubler - Ross in her book Death- The Final Stages of Growth, points out that, “Death is a meaningful, growth indicating aspect of life, the experience of death can help enrich and give meaning to existence on earth (1975, 145). During death human beings lose material, role, physical functions, dreams, as well as loved ones. When individuals lose someone or something they love, the grief feelings may be all they have left. Harboring the necessary selfishness of grief will make it possible for people to hold on to their grief, the closest connection they have to the lost person, until it is time to let go of the grief and hold on to a memory.

The death of a member of family is often a major turning point in dealing with issues in the family. The death of a spouse for example can produce some of the most profound and intense experiences of human emotion and thought. Such a loss elicits a wide range of internal responses, which according to Schuchter are at times overwhelming and at times perplexing (1998, 16). Sometimes tremendous growth occurs – renewing of ties, deepening of appreciation, and intensity of love. While this is not the case in all losses, the death of a loved one in the family breaks a kind of a dam within the mind, and almost at once – whether one wishes it or not, there is a flood of memories. Images, incidences, bits of conversation, shapeless feelings, and sometimes - even hallucinations rush forth. The change that comes with death of a loved one sometimes brings with it a particular intense sadness or revulsions at the memory of the departure of the love one. These losses take a long time to heal. This is because death is a loss that is followed by health issues and bereavement. In the aftermath of a parent’s death for example, the stresses may not be just emotional, but physical as well (Myers 1986, 150). One of the most unusual aspects of parental lose are, in fact the potential for positive change in its aftermath. Other forms of loss bring with them a potential for change as well.


It is extraordinary how dying people count their loss as they leave or prepare to die. This includes all what one had acquired in life, may it be relationship, property not only one loved person, but every loved person in ones life, spouse or partner, children, parents, brothers, and sisters, close fiends, co-workers, fellow volunteers, even casual acquaintances. Losing all their long companionship, the touching, words, intimacies, exchange of opinions, sharing and ways of honoring each other and being together. Losses of ones work, life project, and the sense of contributing to the community. The losses of hobbies, arts, and favorite activities, from cycling to walking the world, photography, jewelry making, tutoring. The sense of purpose and all those activities gave to the dying. The many pressures that cheered one in the past, the delights of the
occasional gin and tonic, perhaps chocolate, and most important of all sex in all its variety and possibility. Loss of the future, with all its plans, hopes, expectations, and possibilities. The ability not to attend to matters of the family, i.e. wedding of ones daughter or see how it all turned out. Worst still it dawns on the dying person that no longer can one revise that past. The dying will also suffer from the grief of the loved ones. In the past maybe one confronted the other but now the dying cannot do so. The dreams have changed.

[1] Withholding of water and food
[2] Informal caregiving refers to family members or friends who provide or manage some aspects of the care of the people who need help because they are ill, infirm or living with a disability.
[3] All those who care for the dying – may they be family members, neighbors, hospice or hospital workers
[4] Response to threat
[5] Finitude is a shorthand way of speaking about the limitedness of everything

Chapter One - Pastoral Care as a tool for Ministry

The role of pastoral caregivers is to create an environment of concern and care to enable those receiving the care to build their religious life. The pastoral caregiver has to put the needs of his/her people in mind. He/she has to use the scripture and exhortation to encourage those in crisis to have the strength to meet the emotional and interpersonal task. Pastoral caregivers should take the time to sit and listen to the care recipient’s special needs and help them fulfill them. The most important is to communicate, and let them know that they are to be listened and helped. Care that is distant is inadequate and harmful. This kind of care contributes to the
feelings of unworthiness, and not accepted by anyone. Pastoral caregivers should bring hope and build ministries focused on pastoral care. As will be seen in Chapter four, the dying, the family of the dying, and the critically ill patient’s need warmth, relationship, and concerned interest in order to experience the goodness of the the end of their living. Pastoral care is involvement of care that helps the person emotionally to control himself or herself.

Dying people needs dignity and wholeness, in live, they need to feel accepted and forgiven, and to feel that they belong and are loved, need to be expressed in spiritual terms. Most people in need of pastoral care however, at some time in their lives have had relationship with a church or a religious body. They may have drifted from participation. At the time that they need pastoral care, they may feel that separation with great anger, great sorrow or both (dying patients and their loved ones deal with anger differently). These patients may want to talk about their fractured religious life, their beliefs and doubts, their anger and sorrow, their desire to relate to god in a meaningful way. In this way they may ask for a minister, to seek the possibility of reconciliation with god within the religious community before leaving this world. For some however, might be fear concerning the next life and their acceptability. The author’s experience with the dying people, while he worked as a hospital chaplain, for most dying people is seeking a sense of belonging and acceptance in this life before it ends. Pastoral care at end of life becomes an important tool to reach out not only to the dying but also to the family and the community as a whole.

A young woman in her early 20s was dying in one of the units the author covered While i was working as a hospital chaplain. Lupus attacked her, which was at final stage. Her mother informed the author that the patient was not converted, and she wanted the author go in and convert her. When the author assured the mother that he would visit with the patient, she was very relaxed that he accepted. This became ministerial starting point with the mother and her daughter (patient), who died a few weeks after. As a chaplain the author used the mother to reach out to the patient, and before she died, the mother was at peace that she will be in heaven. The author’s pastoral care was to both patient and the mother, which became a powerful tool to reach out to the family. In any caring relationship with one in need of pastoral care, the principal responsibility is to be open to individuals in order that they may reveal where they are in terms of dealing with their present attitude of the problem.

Being with persons who are dying and with their families does indeed remind us of the precious gift of life. Suddenly when we are confronted by the deadline of life, a time when life stops in death, there maybe a new perceptive that breaks into life. Time takes on new meaning when suddenly it is a lifetime that is limited. Values are re-examined. Losses that will hurt the most are the pre-occupation of the mind[1]. These are the questions that are raised in us by those who are dying and those anticipating their loss. The pastoral care of the pastor and the congregation needs to begin by allowing the Anxieties of this subject of death, dying and bereavement. Today many families don’t have close, frequent or continuous involvement with the one dying. Many families don’t like talking about death. Many have been isolated from the subject of death for too long.

Death has been an event ritualized in the funeral as a major event but what goes on before and what comes after the event. Kelly further says that “death should be brought into life if we are to receive help for living out life’s ending” (1992, 38). Pastors should care for the non medical needs of the dying; this includes the needs of The family too. This must be about four different levels all at once - emotional, ethical, religious, and spiritual. Many pastors - spiritual caregivers dash simply to identity the spiritual with the religious. Therefore, the pastor must be able to meet the needs of the dying and their family. This will mean talking about death, and the way forward. Stewart points out that, “the tradition of not talking about death with both the dying and their families needs to be consciously reversed, pointing out that also for pastors and pastoral visitors, it’s reversing the trend of talking, even of proclaiming the Gospel” (1984, 57). Since pastors are counselors, they should listen to the dying and their families in order for them to give help. Being present with the person in a manner that says we are ready to listen and help is part of what pastors and other caregivers should be doing. Thus pastors should avoid pre-occupying themselves with the business of praying for recovery, when the dying patient wants to talk about dying. If the patient is going to die and a pastor is telling him/her that we are anxious to listen, who will hear him? Will his/her faith help if spiritual caregivers can’t be with him/her in the faith? When the pastor is giving care to the dying and their family, he is not in submission to
them.

Care is not personal domination. When pastors encounter an individual who has experienced loss or is facing death, he/she can clearly say that “the grace of God abides in the individual” sometimes there is a tendency of thinking that it is good that it is not “I” who is in this mess. Care is not over permissiveness. Pastors may be so fearful of stepping on another’s toes that they veer to the other side and act like “bump on a log” (stewart 1984, 85). Then do they nothing at all. When pastors bring pastoral care and counsel to these kinds of people that are dealing with life crisis that lead to death, they bring values and norms into the context of listening, and they respond to the patient or the family out of context. Pastoral counsel is that he or she does not want life in a social limbo. Therefore, pastors are religious counselors who acknowledge certain values and recognize that the vales will influence the way we help other people. In a religious sense, care means nurture and cherishing - see john 3:16b-17 “for God sent the son into the world, not to condemn the world, but that the world might be saved through him.” As God himself did with us, humans not only love one another, but also keep that other in a special place in affections. To nourish is to feed and nurture another, whether as a mother with a child or a teacher with a student. The pastor counselor nourishes those that he or she is counseling. To nourish is thus to express tenderness toward another, as when holding the face of a beloved. It means that the counselor has to head saying that “i am so interested in you that i want to promote your best interests.”

Stewart points out that, “care means empathy exist a long side another person in a dialogical relationship. This means to be with the other, to stand with the other at the time of crisis or trouble. Pastoral counselors have recognized establishment of the empathetic bond as necessary before one is able to move within a helping relationship (1984, 91). “spirituality and care at the end of life may conjure up a variety of images, some not at the flattering, and further definition is required” (baird 2003, 155). The role of the pastor becomes that of a leader who leads people to meaningful grieving and sharing among themselves. The pastor, so to speak, is a professional who should be concerned in providing better care for the dying person (or already dead person) and their families. The pastor becomes a person involved in letting the people talk about death, dying, and bereavement. It is here that the pastor should encourage those mourning to share stories in ways that they all will know that they are human beings, have experienced life, death, and bereavement. The pastor does not approach the subject as clinician but a pastoral caregiver, who participates in the life process and helping people to express themselves in their philosophy of their feelings of being partners with each other in the journey of life and death. Stewart asserts that, “the Philosophy at this time is not a creed, but exploration and growing in bonds which will bring the grieving individual to believe in honoring the creed and philosophy of every man” (1984, 162). Those gathered to help with grieving should learn from the pastor that the dignity of person hood parents, families, workers, and will nurture the spirit of every person.

The work of giving spiritual care occurs originally and essentially within the spiritual caregiver who is referred to as a pastor or those taking pastoral responsibility. These Caregivers need to keep in mind the questions posed by the person they are counseling or And giving pastoral care. Baird points out that, “the caregivers’ central concern about the counselee might be how to lead the individual feel to supported,” adding that, “for the individual the essence of charity is found in human company” (2001, 168 -169). This is the duty of the pastor to his counselees. The pastor and the church’s role is to take leadership in supporting and developing options of care and counsel of the dying persons and their families.

Story telling as healing

Story telling is the expression of the warmth, better relationships, and connections, both intimate and more remote, in the world and beyond. The substances of these connections are food of the soul. A story told is like a weaving with some of the threads drawn from memories of our experiences and others created and colored by imagination. The memories that make up stories are like the patches of a patchwork. The stories may continue to be told when a loved one dies. Without these memories and story told, we are dead to the soul and disconnected to the real word. For an individual to be connected, murphy asserts that “all stories need to be told, not simply the ones that are deemed to be light and happy” (1999, 26). Stories therefore, can be used to address the normal crises people face daily such as illness and death transitions. Scholars have suggested that stories can also be developed during selective phases of counseling to facilitate the counseling process.


stories, function in the caring setting is to bring healing and wholeness to the lives of persons and families. The African American community is known to use stories to heal Their wounds as a community. For the African American, the stories suggest ways to Motivate people to action, help them recognize new resources, enable them to channel Behavior in constructive ways, sustain them in crises, bring healing and reconciliation in Relationships, heal the scars of memories, and provide guidance when direction is needed. However, Ashby laments that, “at the turn of the century, African Americans are living as Disconnected[2] as they have ever been since slavery” (2003, 103). Story telling is like soul theology, which makes up the faith story that under girds the stories used in any community in caring for others. How that faith story has brought healing and wholeness through storytelling to the lives of people is the subject matter here. The primary element in story telling that gives life meaning as the story is told is what
is hidden in the story, something that envisions hope in the midst of suffering and oppression. the “enigma”[3] element in story telling takes suffering and oppression very seriously without minimizing their influence in life. Relief, hope, and freedom are true realization. As seen in chapter one about the pastor as a counselor and his role. Pastors who understand the working drama of story telling can encourage those hurting to tell their story. Such pastors seek to help parishioners develop story language and story discernment in order to visualize the unfolding drama in their lives. This means that story telling and listening become central to the caring process. Life or at least conscious vital living depends on the telling of stories ( 1999, 24).

Faith stories have therapeutic functions as healing, sustaining, guiding, and reconciling. These can be viewed as a way of pastoral care and are very much part of the narrative approach. Stories thus do impact on people’s lives in characteristic ways: they can heal or bind wounds caused by disease or infection, make peace for those at the end of life, and they can provide guidance to those who make decisions, as well as facilitate reconciliation for those who have been alienated from others. A story will change only when told to a witness who gives it completes attention. The retelling of the story shortens the painful effect, lessens in intensity, and what remains is an imprint in the Imagination, or soul, that then becomes part of the life painting. Buckman in his book,"Don’t know what to say", points out that, “some people don’t talk because their friends never really listen, and in times of crisis, a good listener will create an atmosphere that’s Radically different” (1988, 15). Therefore, story listening is as important as story telling
for it involves empathy[4] hearing the story of the person involved in life struggles. Being
able to communicate that the person in need is cared for and understood by attending to the story of the person as he or she tells it.

Storytelling is a sacred event that speaks of spirit and soul; and while sacred events are beyond time and space, there are some settings that inspire storytelling. If stories are to be told, it is important that the storyteller be given the time and space to tell the tale in full. A model for listening and telling stories comes from the native African culture where the author of this paper originates. At a special gathering of the people, those assembled sit in a circle and elders share their stories. They tell the story in turns and the movement goes clockwise. In a more private setting as in family, the elder (father) shares his stories with the sons while the mother tells stories to daughters. These stories include what happens if either parent is dead, who in the family inherits what, among other stories. When stories are not told people break by harboring suffering and problems that they could have eased by sharing with others. Or still one departs the world by death and leaves his loved ones with guilt and in darkness that the departed did not communicate anything. Murphy adds that, “there are families that no one has ever told a complete story, and there has been no practice in listening and witnessing without passing judgment” asserting that, “the most import role in the telling stories in families is the role
Played by the witness”(1999, 34). Human beings need witnesses especially at the time of vulnerability, such as at death, and at many times in between. Family meeting is a sacred time for the family to gather when one of their members is dying so that each can tell his or her story. If storytelling and listening to those who are terminally ill or dying is so difficult as some would argue, why try it? Why is it worthy doing? What can one achieve by talking or listening to someone who is seriously ill? Buckman argues that, “in giving support and easing distress, both the donor and the recipient are rewarded. These actions have worth and the value because they strengthen one’s relationship with the other. They make new bonds between them. In many circumstances people talk to get what is bothering them out of their chests, and to be heard. There is relief to be found talking, which means that there is relief one can provide for the sick person by listening and by simply allowing them talk. Bottled up feelings may cause damage because, in many cases, people are ashamed of their feelings, particularly of their fears and anxieties. One of the greatest services one can do to a friend is to hear fears and stay close to the person in listening. By not backing away or withdrawing, one shows that one accepts and understands them” (1999, 13). This will help the patient/dying to get his or her sense of perspective back.


The crisis of loss through death creates feelings of interruption of important communication lifestyle, and sustained relationships that have been taken for granted. It is also a discontinuity in the existing narrative of life, because the experience of loss is the disruption of a narrative. The death of a loved one cuts short the life story one has been living. For many, death means fashioning a completely new story for one’s life. Patterns of interaction are disrupted by the death of a loved one, resulting in restlessness, inability to remain in one place, an aimless moving, continued search for something to do. As dower puts it, “ there is also lack of any capacity to initiate and maintain patterns of activity, for the grief sufferer discovers that many of the activities that were done with the deceased have lost there meaning” (2001, 37). When death strikes, it is wise for the living family members and friends to form a group, or a fellowship to help one another. Dower further observes that, “the group together with its leaders, (pastor, counselor, etc) will help to strengthen the support group for one another. All of the members will became facilitators of grief process among members of the family and the entire group. In the preparation service, the group will stimulate each other and express their feelings concerning the beloved family members already bereaved. The support group becomes a therapy system. The therapist job in this case is to help the grieved family finds their unique path through the grief” (dower 2001,37). Dower cautions that having a therapist doesn’t always mean doing it their way.

It means having one-on- one support as you do it your way. There is what used to be called the parent network, which provides strong emotional supports as well as help one another care for the family. This type of group understands the manifold problems, and receives input from other persons joining the group. The beauty of the group is that one does not have to become a client. The individual can utilize the serves in a way that serves his or her needs. After death many
families live in isolation feeling very lonely in their situation and not having anyone who truly listens and understands them. According to donnelly, “the need to reach out and not feel so isolated is extremely important” (1980, 190). It is in such circumstances of coming together that the group will discover that many of them may at some time have had bereavement in their lives too. This means that they automatically know what to do in terms of the crisis of loss. The idea would be to exploit many of those natural leanings and involve these persons in discussion groups surrounding such crisis. According to Kubler- Ross, “Members who have stayed in their local support groups years after the death of their loved one, listen sympathetically to the newly bereaved, vividly remembering how important it was to be patient, and offer them a phone number to use when the loneliness becomes unbearable”(1983, 235).

Today many new approaches have been initiated to help young grief-stricken families. (sources of helping in airing and resolving experiences)- share (kubler-ross 1980, 166). The group is called share and this is the purpose of the group. For the members who are bereaved to be able to share their feelings, the basic need of share is the comfort and mutual reassurance that those who have had an experience of loss in their families can offer each other. In this way the family has the opportunity to share their feelings and to receive understanding and support. Through the local share meetings, members can share their experiences, thoughts, and feelings. Those affected learn that the intensity and longevity of their felling are normal. Members gain a sense of wholeness when they realize their problems are not unique to them alone, but rather problems with which most bereaved families are struggling. In share healing is slow and promoted as those affected by the lose of a loved one gain insight and understanding, have an
opportunity to ventilate their feelings in an accepting atmosphere, and reach out to the other members of share who have experienced the same loss. Kubler points out that “what is important in this group is an acceptance of each individual”(kubler-Ross 1980,166). Another way to help the bereaved individuals in support systems is to help them dive right in the group and let them ask for what they need in the group setting. Is the Individual confused about the grief? Dower suggests that, “ongoing discussion with other people might help those grieving”(2001, 190). However, it is important to observe that at the time one is grieving over the loss of a loved one, the primary feelings are those of detachment. Most individuals at this time are lost from the real world, and to them nothing that is alive and part of this world looks real.

During grieving period, many affected people have the inability to concentrate on anything for any length of time. They hardly become absorbed in the conversation that the group is sharing. Nancy whose husband had died, observed that, “conversations with friends could hold my attention for only a short while.”(schiff 1977, 24). This may take a period of time before the
individual can begin to function with reasonable normalcy. It is during this time when individuals are withdrawing themselves from the real world, that the support group become important. Even though the pain of loss is great, the group helps begin the first step out of the cocoons of mourning and back to the land of the living. The group helps in taking some positive teps towards reality. Although each extreme bereavement response is tragic, individuals act differently. Some may remove themselves from the prime source of easing their hurt- the company of their fellowman thus group support becomes infective. Methods people use in coping or trying to cope with grief are as varied as people themselves. The support system may not be right for every individual experiencing loss. Some things however, can apply to most adults. For young people, and most adolescents, fear public displays of emotions. Their greatest fear is being perceived as different from their peers. But it has been suggested that the most helpful thing to do is to find them an opportunity to share their feelings with others. Experiencing thoughts and feelings to receptive peers and adults provides a sense of release - an opportunity to identify misconceptions and rectify them and help build and strengthen one’s support network (siegel 2002, 10).

It is important to note that many who lose a loved one, most times have the feelings that those who come in the name of support are patronizing them. The grieving persons may have questions whether those trying to help them really understand what they are feeling. It is true that some do not have an idea of what the grieving family is feeling. Many would make statements like, “god knew what he was doing.” At this time of grieving most people do not want to hear about god. Most people withdraw themselves to an extent that they may not want to talk about their religious experiences. Donnelly points out that, “doris who was grieving over the loss of her child avoided talking to people to an extent that she often would not answer the phone” (1992, 113).

The role of the support group is not to give answers as to why death has come to ap articular family but to support the grieving family as they mourn and grieve. The support group is in place to encourage the individuals mourning to open up and talk. This helps them relieve their emotions. The group becomes like a therapy group whereby individuals in the group can make statements to lead the grieving family to speak out. “Maybe there is something you want to say.” (donnelly1992, 113). Making an open question or statement this will help more than anything else because this will help the person mourning to pour oneself out. However, other times the affected families would want to stay away from people. They may feel that what they need most is to stay together, to encourage each other themselves. Some bereaved family members feel it sacrilegious to talk about their loved one death, while others wants to talk about it constantly. Under this kind of circumstance the support group may not know which way to more on. Bringing up the subject would upset The bereaved family. It is the duty of each support group to weigh the situation and act according to the needs of each situation. Some would want to go to parties, movies and other gatherings to keep themselves busy in the mind. Others would fear to bring the subject of death for they are afraid that family members would burst into tears. Many counselors agree that tears during grieving time are healthy. Kubler - ross asserts that, "most troubled are those whose support system is not available at a time of crisis” (1983, 41). Some grieving families would want to receive help from the works of their spiritual leaders, like pastors, imams, rabbis who take them to higher understanding of life and death without minimizing the nature of their agony and death loss.

There is no doubt that many people obtain worthwhile support from their religious beliefs throughout their lives. Christians, muslims, jews, buddhists, and others hold views of life and death that help them accept their own deaths with serenity and see the positive side to the loss of someone else. The role of the support group is simply as a catalyst, to share a moment, a tear perhaps, hope, and most of all to lend a listening ear. According to montgomery “those who belong to a group that is involved in sharing in the time of death crisis, together - a family, a work team, a local community - it can be helpful if someone initiates the chance for the members of the group to share the feelings”(1989, 120-121). Support group members are encouraged to talk about their feelings and reaction about the death crisis. One of the great fears among critically ill and dying patients is that pain uncontrolled may escalate beyond wildest imaginations, that one may cry out, and that loved one may not be able to recognize their pain. When people are in pain, there is no denying their discomfort. No matter what you hear, no matter what you believe, the person’s pain is real. A person’s pain and response to that pain is personal. The pain exists within the person’s own physical body and his or her own response is unique. All pain has a psychological component, no matter what is causing it. Pain is no stranger to humans and they have relieved it in a number of ways. Because of some life hreateningIllness, some people are probably stuck with pain but some people can exert a lot of control over how much, how intense and how it interferes with life. Some patients suffer in silence, determined to be staunch and brave; they may even try to conceal their pain. Some patients are embarrassed to complain (weelnosen 1996, 101). Pain relief is now moving in a newer direction, from a humane concern for the suffering of the dying to recognition that pain is actually unhealthy. Pain is stressful; it can inhibit improvement or recovery, limited activity, decrease appetite, and interrupt sleep, slow fighting the disease, raise blood pressure, and increase anxiety over future pain, thereby increasing pain, and depression that alters the immune system. Today pain is recognized as an ailment in itself with negative consequences. The author may want to look at pain treatment and as way to heal pain. The american pain society (aps)[5]contends that the medical community must become aggressive in treating the pain associated with fatal illness particularly since severe pain can couse patients long for death. The aps maintains moreover, laws must protect health professionals whose use of painkilling drugs unintentionally hastens a patient’s death (williams 2001, 69). Since it is the opinion of many that terminal illness is often accompanied by severe pain and other symptoms at the end of life, painkillers are advocated for administration even when death seems preferable.

According to marcia Levetown, pain and palliative care education consultant, houston texas, “no physician May be subject to disciplinary action by the board for prescribing or administering
controlled substance in the course of treatment of a person for intractable pain.” (seminar on whole person assessment, pain at the end of life, 2003). Pain and other symptoms at the end of life can usually be relieved if clinicians have the training and resources to focus on this goal, but current treatment often falls short of this goal. Patients can be reassured that in the occasional case where the best treatment cannot allow the patient to be alert and relatively comfortable, intravenous sedative can relieve all symptoms in the last days of life. Despite the best intensions of clinicians, pain and symptoms control is often suboptimal because the entire healthcare system has been designed around cure of diseases rather than palliative care. The world health organization (who) defines palliative care as: the active total care of patients whose disease is not responsive to curative treatment. Control of pain and other symptoms, such as psychological, social, and spiritual problems are paramount. The goal of palliative care is the achievement of
the best quality of life for the patient and family.

[1] See chapter two for more details of dealing with fears and concerns.
[2] Disconnection refers to the inability to come together for mutual support
[3] The hidden meaning in a story
[4] Empathy means attending to the person with our presence. Verbal responses to ommunicate that we have understood and are seeking to understand the person’s story as it unfolds.
[5] APS is the U.S. chapter of the international Association for the study of Pain, a group of clinical researchers investing the treatment of pain. Its 3,000 members including many of the leading basic and clinical researchers in the epidemiology, mechanisms, and treatment of acute and chronic pain caused by the range of human diseases.