Tuesday, December 30, 2008

Geneva

Wanted a promise that her pacemaker would be disconnected after she died.

Geneva had her own strange request as she entered the shadows of her dark valley. She was a sixty-eight-year old Congestive Heart Failure patient (CHF) who was very proud of her "modern medical miracle," as she called it. It was a pace maker to keep her heart in its proper rhythm. She had lived in the Georgia Mountains all her life. She was one of eleven children who knew how to work, sweat, and till the earth in order to survive as a mountain farm family.

Geneva was a big woman who loved hard candy, soft snacks and soap operas on TV.When I first met her she proudly told me about her church and how proud she was of her pastor. I asked, "How often does he come to see you?"

She said, "Not too often, but you know he is so busy." It seemed strange to me that country folks protect their pastors and find excuses for their lack of pastoral activities. I got the feeling that as proud as she was of him, she felt that he spent too much of his ministry time, with people who were not church members rather than his parishioners.

He was a go-getter of a minister in the community, member of several civic organizations, president of one of them. He served on a board of trustees for one of the local banks and was active in the local chapter of the American Cancer Society. One of the first participants in the three-day training program for hospice volunteers, he also made several missionary visits to the Caribbean Island where his church was sponsoring a small mission. After his completion of the training as a hospice volunteer, I was never able to get him involved in working with any hospice patients. He was a hometown boy who had grown up among the country people he served and was a product of that hill country culture.

When I came to visit Geneva, she would be in her small bedroom in the doublewide trailer-home belonging to her daughter and son-in-law. Her room was cluttered with copies of various translations of the Bible with religious magazines lying on the bedding within easy reach. Bowls of mints and other kinds of candy were spread about the room and, of course, the TV, so she could keep up with her "soaps." I was careful not to visit her during her "soap time."

When I would come in to visit, I would always ask her, "How are you doing today?"

She would let out sigh, from deep within and respond, "Oh, I'm about the same."

Sometimes, she would talk about her early life as a young woman hiking about the countryside or working on her father's small dirt farm in the Georgia hills. She would share stories about her family and how many of them had died over the past five or six years. She felt it was an honor for her to be the last one of her brothers and sisters to still be alive. She wouldn't talk about her deceased husband. I never really understood why. It was as if she was never married. I felt that it was a cultural secret that was forbidden ground not open for conversation.

Geneva's only daughter Nell was her primary caregiver, who had enough problems of her own but appeared to appreciate having the opportunity to care for her mother. Nell's son had moved back into the home to help with his father whose cancer showed up again after a ten-year remission.

Nell had a speech impediment that almost caused her to swallow her words. She was also fighting various stress-related illnesses from diabetes and suspected lupus along with nervous stomach and migraine headaches. All of these stress related maladies were in addition to her responsibility of taking care of her mother and her husband. It was not uncommon for her to have to make two or three trips to town during the week to see doctors: hers, her husband's and her mother's. These appointments kept her running most of the day causing more stress and pressure. Geneva would say to me, "I feel so sorry for Nell, she has no time for herself."

I suggested, "Your daughter may feel honored to be able to help you at this stage."

She looked at me as though she had a new thought, and smiling, she asked, "You think so?"

Geneva's illness seemed to linger on and on. Then her son-in-law's cancer began to take its toll on him and of course this added more work for Nell who was both her mother's and her husband's primary caregiver. A decision had to be made as to what they could do for Geneva when her health declined further and she would need closer care and supervision. Two things happened almost simultaneously. Geneva began to decline and could hardly get out of her bed. Her son-in-law's cancer worsened. The decision was to move Geneva to a personal care home, so that Nell could care for her husband, whose cancer was progressing and who needed constant care.

Geneva didn't do well away from her own bedroom and all its accouterments. Her health declined even more rapidly as she passed deeper into the shadows of death. I would visit with her and talk to her about her approaching death. She would say, "Whenever God wants me, I'm ready to go." In one of our conversations we talked about what it would be like to die.We talked about the freedom the spirit would have in the presence of God. We talked about the Christian dichotomy of wanting to go to heaven, being free of pain and discomfort, with no sorrow or tears and then also fearing to leave this life.

One day, when I approached the subject of the hereafter with Geneva, she said to me, "I want to be sure that when I die the mortician turns off my pacemaker. I don't want it to start up after I'm in my grave." I started to laugh, but noticed the serious look on her face. Her fear of walking in the valley of the shadow of death was honest because of her real fear of waking up in a casket buried six feet under the ground. "You know," she said, "you read that sometimes when they dig up a body they find scratch marks on the inside of the casket top."

I suggested to her that today that was next to impossible. However, she only became content in her burial thoughts and plans when her daughter promised to carry out her last wish: that she would be sure to have the funeral director remove her pacemaker from her chest. I will always think of Geneva resting in peace with her pacemaker turned off.

Country culture is a lesson in itself. These wonderful country people have a wholesome way of walking through the valley and dealing with the dark shadows that are looming in their life. The faith of their childhood sustains them in the days of their impending transition. The memories of their past bring them comfort as they review their life before they walk out of the valley of death into their new beginning.

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Tuesday, December 23, 2008

Hal

His wife told me not to call their pastor because he knew where they lived.

The church coming into the home was not the situation for Hal and Helen. Hal was a very active Deacon in a small country Baptist Church. He taught Sunday school. He was a trustee and a leader in the true sense of the word. He and his wife Helen were two of the charter members who helped found the church.

Helen called hospice requesting help. Hal was two years into the last stages of his
Alzheimer's disease. He also had prostate cancer and had been confined to his bed for over the past five years. Now he seemed to be consistently crying in pain. Helen could do nothing to bring her husband relief.

On my first visit to their home I drove up in the yard and parked next to their trailer. I knocked on the door, but no one responded. Then I heard someone shouting from the back of the trailer, "Come on in." I entered into a very clean and fresh living room. Helen was in the back bedroom with Hal. "I'll be with you shortly," She said. As she came into the living room taking off her rubber gloves, I noticed her hair was all frazzled. I could hear Hal in the back room moaning and yelling incoherently. "Please excuse the way I look." She paused for a moment, looked back toward the bedroom. And said, "Don't pay any attention to him. He can't help himself any more."

I introduced myself and handed her one of my hospice cards. I told her that I was there as part of the hospice team to do a spiritual assessment and to offer any spiritual assistance she and Hal might need. She asked, "What denomination are you?" Then, before I could respond, she quickly added, "It doesn't matter."

I asked her to tell me about her husband and when he got sick. She shared her long and agonizing journey through the valley of shadows of Alzheimer's, walking with her husband Hal all the way. She went on to tell me about their religious experience since they were married. They had been charter members of a small country Baptist Church, meaning they had been in on the starting of the church.

She had a certain excitement in her voice as she told me how active they had been in the church. Hal, a deacon and trustee, had taught Sunday school and served as the Sunday School Superintendent.

She added, "I was president of the Women's Missionary Society."

She was also president of the Church Social committee that was responsible for helping families who needed assistance during funerals and crises. (That is a country culture activity practiced by most of the country churches, which provided a meal in the church activity room for the family and guests after the funeral service). She told how her church grew and how proud she and Hal were, to have been a part of that growth.  Our conversation went well beyond the normal assessment of gathering information.

As I was finishing my visit, I asked her about her pastor. "How often does your pastor come by to see you and Hal?"

She gave me a sad smile. "Never," she told me, then caught herself and explained. "Well, when Hal first got sick, when we couldn't get to church too often, our pastor would come by from time to time. But," she paused thoughtfully, "I guess it has been over five years since he has visited with us since we stopped going to church."

"Does anyone from the church come by?" I asked.

"Not lately." She admitted.

I must confess I was somewhat in shock. "Do you mean no one from your church visits you or has prayer with you?"

“Oh, I guess they used to have prayer for Hal at prayer meetings, but I don't know what they are doing now."

"Do you want me to call your pastor?" I asked. It is a question that I ask all my patients when I'm doing their spiritual assessment.

By now tears were running down her cheeks. Her eyes opened wide in a flash of anger. "No, not now. He knows where we live!"

Their pastor never came to visit them while they were in the hospice program. Hal and Helen struggled with Hal's illness for three years before he finally died; he was on the brink of dying during the whole time. Helen continued her refusal to allow me to call their pastor. She told me on a number of my visits that she wanted me to do the funeral for Hal when he died. One time after a difficult weekend she added, "If he dies." Then she laughed.

Unfortunately I was away on vacation when Hal finally came out of the shadows into his new beginning, and I was not available to preach his funeral. Helen; in spite of her angry feelings, asked her pastor to do the funeral. On one of my bereavement visits after I returned, Helen said to me, "I asked the pastor to do Hal's funeral because other church members expected me to." I learned that customs have a value in the life of country families. The pastor was proud to do Hal's service because, he said, "He was Hal's pastor."

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Friday, October 24, 2008

Bill

A minister who chose to die, maybe.

The mountains of North Georgia are slowly being infiltrated with retirees from the greater Atlanta area. You hear complaints from the old timers in these mountain towns, that foreigners are invading them. One such foreigner was a retired former pastor of a large First Baptist Church in a suburb of Atlanta. His congregation and friends called him "Doctor Bill". His doctor's degree was in pastoral psychology and family counseling. He was not only a former pastor; he was also a former counselor who had a counseling practice.

Brother Bill, as I called him, was sixty-three years old. He came into hospice with two brain tumors and the usual "six-months- to-live-if-the-disease-followed-its-normal progression." He planned to defeat the normal progression of his illness by being positive in his treatment.

Like most of the other ministers that hospice had as patients, he did not have any use for the hospice chaplain when he first entered the hospice program. He had a dark past of personal problems that had followed him into his dark valley of the shadows and didn't want another minister of any kind meddling in his affairs.

His second wife, Judy, was twenty-five years younger than he was. He liked to brag to the hospice staff about his robbing the cradle. He told the intake nurse that he had been married to Judy for fifteen wonderful years and that his marriage to her was the best thing that ever happened to him. The rest of his family consisted of two children, a son and daughter by his first wife. He also commented to the nurse that they had started to visit him and had forgiven him about the divorce since he was diagnosed with the tumors. "Something good has come from this mess," he said.

Bill was an individual with a strange sense of humor that often caught our nurses off guard. For instance when the nurse went out for her first visit after the paper work was complete, she returned to the office angry and upset. Bill met her at the door with a 22 pistol in his hand, and said to her in a rather loud voice, "You're just in time. I was going to shoot myself. You saved my life." He then smiled and invited her in with a blessing. "God bless you, my sister." The nurse told the hospice team that she almost turned around and headed home. Then more seriously she said, "We had better watch this guy."

Bill told me later when we finally got acquainted that he had been out in the back of his house shooting at crows that were destroying his garden when the nurse rang the front door. So, he thought to himself, here is a chance to have some fun.

As I mentioned earlier, he did not want a chaplain to visit him. He asked the nurse to complete his spiritual assessment if one had to be done. The nurse told him, "It's not in my job description but, perhaps the hospice social worker would be able to do the assessment for the chaplain."

Bill agreed to that, saying, "If I have to see one of them I prefer the social worker. She is a woman isn't she?" He allowed the social worker to visit once a month. Three months passed by and I only knew about him from what the other team members shared at the team meetings.

When I learned from the social worker that Bill was a former pastoral counselor, I suggested she tell him that I might need some counseling help, and maybe that would get me into his house so I could get acquainted with him. He had begun to trust the hospice staff, so when it was suggested that I might be able to get some help from him, he told them, "Tell the chaplain to stop by some time."

On that first visit I made with Bill we hit it off. We found out that we had many things in common.We also shared the same opinions about our mutual non-satisfaction with our denomination. It was an added plus when his ugly little dog jumped up into my lap and gave me a wet kiss right on my lips.

After we got acquainted, Bill and I shared many wonderful hours in his study, talking about church politics, working with counselees and generally agreeing as to why our country was going to hell. He shared his counseling techniques with me and we spent time discussing problems we both faced as pastors. One wonderful sunny Georgia afternoon he took me for a ride in his pontoon boat that was docked at the marina in his sub-division.

Bill was a minister of faith who had set up for himself a prayer chain across the country. He had many minister friends, former counselees, and extended families that agreed to pray for his healing at a certain time on Monday,Wednesday and Friday. He also was well informed about the latest diets, herbs, and vitamins that would reduce his tumor and defeat the cancer.

As time went on it appeared the prayer chain was working and he began to get much better. The doctors said his tumors were shrinking. One of the tumors finally disappeared completely. He told me that he was going to revoke himself out of the hospice program as an act of faith that God had answered his prayers for healing.

I went by to see him just before he asked to be taken off the hospice roll. We laughed and cried and praised God together. He shared his plans to write a book about some of his experiences since leaving the ministry and about his miraculous healing. Then he told me a wonderful April Fools' joke he pulled when he was a pastor in the First Baptist Church and a member of the local civic service club.

He began by tell me he was the only member that was ever black balled and kicked out of the club.We both agreed that when a minister belongs to civic groups and clubs, the membership sometimes treats us with benign contempt. It is most noticeable when they are telling off-colored stories. "Excuse me, Reverend," they say and then they continue with their smudgy little story or joke. Someone in a group will say a cuss word or two, and then look at the preacher and say, "Oh, excuse me, preacher."

Bill had been elected as the club historian. At every meeting he would be asked if he had anything to report. He usually passed. One year there was a certain club president named Victor that he just couldn't stand. He was local lawyer who irritated him to the max with his off-color jokes and his sarcastic comments. This guy was a jerk who was always making wise remarks about him. Than he would laugh aloud as though he was kidding.

Bill prepared the stage for his revenge. The next meeting was scheduled for April first. He went down to his church basement and found a large ceramic flower vase, left over from some funeral. It was about two and half feet tall. He wrapped it in plain brown paper and took it with him to the monthly club meeting. When the various committees were asked if they had a report to give, Bill stood. "I have one today," he said as he walked up to the podium. He took with him the vase wrapped in plain brown paper. Then he began his report:

"You all know that last year my church sent me and my wife to the Holy Land for our anniversary." Some of the heads in the audience began to nod in agreement. Bill continued, "We had a wonderful time. I always wanted to visit the holy sites and other sacred places. Then when we were on our way back, we took a side trip to Egypt to see the pyramids. One evening while we were looking in one of those little tourist shops I met this fellow who told me he had an antique vase that he found in one of the smaller unpopular graves or pyramids. I looked at it. It seemed old, but I had my doubts. This guy kept insisting that it was authentic. So I broke down and paid him a hundred American dollars. I know it was crazy, but somehow I was able to smuggle it back into the States. I told the custom's inspector that it was a souvenir for my church."

Then pointing to Victor, the president of the club, he said, "Victor, come on up here a minute and give me a hand."Victor looked around, a little uncomfortable being on stage with the preacher, but came and stood next to him. Bill went on with his story. "When I got home I found a collector of artifacts in New York who said he could get the vase authenticated for me. So I let him take it, to see if it had any value at all. It seemed to take forever. I had almost forgotten about it, but just last week I got it back from him with a letter of authentication."

He then held up a letter with a fancy letterhead. "The tests turned out great. The letter I got from the curator said it is an authentic Egyptian artifact dating back to the year 750 BC. It's worth about $250,000 dollars. I thought that since I'm the club historian I would share this moment with all of you and open it up today, with our president's assistance." Then turning to Victor he asked, "Will you give me a hand and help me with the unveiling?" Victor was beaming a pompous grin as he took his place on the other side of the podium across from Bill.

Bill continued telling me his story. "I had it tied in such a way that at the right moment when Victor was untying his side, I gave it a little tug, and wham-o! Right out of the president's hands and smashing onto the marble floor the vase broke into a million little pieces. The whole club grew deathly silent. A sense of deep despair filled the whole room. Then I leaned into the microphone and with a big pastoral grin I said, 'Aprils fools!' No one laughed. Victor turned red with anger and embarrassment and walked out in a huff. A month later, I received an official letter from the Club's National Headquarter suggesting that I was no longer a member in good standing because I had missed too many meetings in the past year.

I laughed until my sides hurt. Bill was laughing as he told me his story. Tears were running down from our eyes. That was our last story. Bill revoked out of hospice the next day. The hospice team celebrated his cure along with his fami ly.

I didn't see Bill until six months later. One Sunday afternoon my wife and I went house hunting in his community. We stopped by Bill's place to say hello to him and see how he was doing. His family was there as well. He was sitting in his old recliner, smiling and proud as could be as he introduced me to his children and grandchildren. He had a welcome smile, yet I felt something was going on. It just seemed that something was wrong.

The rest of the family and my wife went out back to look at his garden. Bill stopped me, as I was about to go out with them. "Wait a minute, Don." I stopped by his chair. "It's back." A tear ran down his cheek. "The tumor has come back." He wiped his tears. "I really thought I beat this damn thing, now my family and I have to go though the whole mess again. I don't mind but, I hate to put my wife and kids through this."

"Does that mean you're going to be coming back to hospice, and I can get paid for visiting you again?" I jokingly asked. That was stupid, there's nothing funny going on here.

"Maybe," he said, with a half smile.

His wife and family returned from the garden. We shared a lot of small talk, joking and kidding about the grandchildren. I told him I would see him soon. My wife and I said goodbye and went on home.

The next morning, around ten o'clock, Bill's wife called me. "Don, Bill died this morning. I thought you would want toknow. He was sitting in his chair when I went to work and I thought he was still sleeping. When the housekeeper came in she found him."

Do I have questions about Bill's death? Sure I do. He was the type of person who didn't want his family to go through the dark shadows again. I thought to myself when I heard the news, I bet he took his own life and was saying goodbye to me yesterday. I'll never know, neither will his wife. He would never lay that kind of trip on her or his family. Well, all I remember is that he was very contrite on Sunday. With his family he put on a front of being happy. When he talked to me, I could see another message in his eyes. He seemed angry and sad that he was about to travel into the valley for the second time. Was he right or wrong? No one can be certain what really happened. He may have made the choice to start his new beginning.

My learning experience with ministers and pastors who are hospice patients is that they are no different from other dying patients. They feel the dark shadows around them, they trust their faith and religious values and cultural values, and they pray for a miracle.

Sometimes the community of believers lets dying patients down by not being closely attentive to their spiritual and other cultural needs. Religious culture and spiritual values are only two of the elements that make up the human community and the culture that we all live in. Family values, heritage, economics and one's location on this Planet Earth must also be taken into consideration when there is a discussion on cultural aspects of the dying.

I'm sure there are other aspects to the religious culture and neglect of dying church members by pastors and church members. I am not in any way making a scientifically proven statement. My information, thus my opinion, comes from my experience with patients I knew in the hospices' where I worked.

Part of the spiritual assessment that I had to do when admitting a patient to hospice was to ask the patient or caregiver if they wanted me to contact their minister or clergy, priest, rabbi or whoever was their spiritual leader. Very few allowed me to do so. Most patients, caregiver and other family members would say their pastor knew their situation. They often went on to add, "He knows where we live."

Before my next story, I want my readers to understand that many in the community of faith have an outstanding ministry visiting the sick. Pastors and members of several country churches I had experience with in hospice came to visit their sick members weekly. Visiting dying members they would bring a prayer group
and choirs right to the home to conduct a worship service. They had the country culture tradition of providing religious and spiritual services for their members who couldn't come to church. So they brought the church to them.

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Friday, September 19, 2008

Charley

He didn't fear death, he feared the process.

Charley was another smoking former country preacher who believed he had gotten sick because of his sin of tobacco use. He said that, he couldn't quit no matter how hard he tried. It became an excuse for him because after he said it, he would take off his oxygen tube and go to another room and light up his Lucky Strike. He believed he was a spiritually weak person who deserved his fate. His fate consisted of advanced emphysema and congestive heart problems. However, he continued praying for a miracle while enjoying his destructive habit of smoking cigarettes.

Charley had pastored several local country churches on weekends and worked in the small town as a shoe salesman in the local clothing store. He often expressed to me that he felt as if God was punishing him for his sin of smoking. He would not listen to me no matter how I tried to convince him that God did not operate in that manner. He continued to believe his illness was punishment for his sin. It was almost as if he wanted to have something to blame. He truly had a big smoking habit. I dreaded going to visit him because of the second hand smoke that fogged up the house. Charley, like Herb, was fearful of being in the dark valley of the shadow. He would do everything and anything to keep the death angel from knocking on his door. Anything, that is, except, stop smoking.

When he was first admitted into hospice, the admitting nurse made sure he understood that hospice tried to keep their patients from going to the emergency room whenever they felt scared about what was happening to them. "Call our office first," she told him. His fear of suffocating caused him to become anxious when he faced pain and he feared he might be dying. He would call his doctor, and to appease him, his doctor would tell him to call hospice and go to the emergency room. The emergency room doctor would give him some medicine, the same as he could have taken at home and then they would send him home.

I approached him one day about why he was so anxious. I came right out and asked, "Are you afraid of death?"

"No, I don't believe so," he said.

I went on, "I was wondering why you go to the emergency room so often. They give you the same medicine you have here in your home don't they?"

"I'm afraid I may not take my pills the right way," he answered.

"How's that?" I asked.

"You know, I get so scared and nervous when I start suffocating and I think maybe I'll take too many pills."

"Sounds to me like you're afraid of death." I said.

"No," he answered. "I'm not afraid of death, it's the process that scares me so much."

I couldn't argue with that. After working with hospice patients for over seven years, I too fear, the process more than the event of death. Charley re-taught me an old truth about myself. I had to learn it over again and again. That is, as a chaplain who once faced his own death on a firebase in Vietnam, it was the process, not the event that I feared when it came to dying. I know that I don't want go through the valley of death and all those dark shadows if I can avoid them, but that is not my choice. It wasn't Herb's choice nor was it Charlie's.

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Wednesday, August 27, 2008

Herb

A typical country preacher who struggled with life and death.

Herb was what I would call a typical country preacher. He didn't like to be called Reverend, Minister, or Pastor. He said, "Call me preacher because that's what I was called to do." I first met Herb when he was admitted into our hospice program while he was in a local nursing home. He had severe lung cancer and had suffered a stroke that confined him to a wheel chair.

When I went into his room to do my spiritual assessment, I noticed that he had hand-carved wooden cross, religious pictures and family snapshots pinned to the wall. Two well-worn, tattered, dog-eared Bibles that had been obviously read and re-read through the years lay on his nightstand. I knew that he had been a local minister who had served as bi-vocational pastor in at least six Baptist congregations in the mountain area.

I tried to make a talking point with him about the cross on the wall and the Bibles on his nightstand, suggesting that religious symbols can be a comfort when we are too sick to read. Herb was not in the mood for talking. He made it a point that he didn't want to talk to a minister. He only consented to my visit when a nurse told him that the chaplain visit was part of the hospice admission process and paper work.

Herb was admitted into hospice because he had lung cancer in its final stages and his wife could not, or would not, care for him at home after his stroke. He was getting weaker by the day. The nursing home staff suspected that the cancer had metastasized to his bones and to his brain. He had difficulty getting around, having to use a wheelchair for which he had a profound hatred. He got angry when someone tried to move him out of his room and spent the rest of the day complaining to anyone who would listen.

As time went on, his depression appeared to worsen. The hospice nurse kept suggesting to him that he allow the hospice chaplain to visit, pointing out that perhaps he could use a prayer partner. After more than a month of her persistent effort he finally agreed to let me visit once a month.

Herb's depression was obvious. He would lie in bed turned toward the inner wall. At times he might turn to me when I came to visit, but most often he would remain with his face turned to the wall away from me or any other visitor, which sometimes included his own grown children.

I remember when I was about to end one of my early visits with him I asked, "Do you want to have a prayer before I go?"

"No!" That ended that.

One afternoon I asked him, if he had another pastor coming by to visit?

Again his response was short and to the point. "No!"

"Ok," I said. "How about letting me act as your pastor while you are in here? I'm a Baptist like you, and I can stop by to visit when I'm in the nursing home visiting other hospice patients." He gave no reply.

"Look, Herb," I said," I'll see you again next week, Ok?" When I left, I thought to myself as I walked down the hallway, I should increase my visits since he did not object. Maybe he's getting used to me.

A week later on my next visit to the nursing home, the floor nurse requested a talk with me. She began to tell me about Herb's recent behavior. "He cusses the aides and nurses," she said. "He even threw a food tray on the floor and told me to get out. Chaplain, see what you can accomplish with him. We can't seem to do anything with him."

I told her that I would look in on him. I told her that the hospice team had also noted his aggressive behavior as well.

"Did you know he was a local preacher?" the nurse asked.

"Yes, I understand he pastored several churches in this area."

"He did," she went on, "until he got a divorce." Then she said, "You know, he left his first wife to whom he had been married for over thirty-five years. Caused quite a scandal around town. He has four grown children; you might have met them. After his divorce he married a local woman who is younger than his oldest daughter. Now, I understand his new wife is running around with another man. You know she put old Herb in here because she didn't want to take care of him at home."

"No, I hadn't heard that. Thanks for your information. I had no idea." I went on to say to the nurse, "No wonder he is depressed most of the time. That's probably why he appears so angry, too. He seems to have a good reason for being upset if his wife is running around while he is in this place."

As I was getting up to leave the nurse continued to talk. "I don't understand a minister who all his life preached about heaven; where we know there is no sorrow or pain or tears and now he is so afraid to die. You would think he might be a little anxious to get to heaven."

My thoughts were a little different. Wow! No wonder he is depressed. He is a country preacher who believes smoking is sinful and he smoked most of his life. He also no doubt believed that divorce is wrong and sinful. And not only that, he remarried and that, to his belief system means he is now living in adultery. He probably knows his new wife is running around with someone else. He knows he is dying and he is still married, still living in adultery. Therefore, he might be afraid of dying and going to the very hell he preached about so vividly when he was an active country preacher.

Putting together what the floor nurse said about him and adding the other information that I had been able to glean from Herb himself, it was easy to surmise why he might have thought that his illness was somehow related to his "sin" of smoking all his life, and his adulterous relationship with his second wife. In one of our bedside conversations he indicated that he deserved his cancer.

I began to understand where his fear was coming from. It stemmed from his country religious, conservative, fundamental culture. Strict fundamental preachers often leave no room for God's love and forgiveness to operate in their own life. They forget the message that they preached so often to others, that God is love and God will forgive.

I stopped by Herbs' room one afternoon and caught him in one of his few good moods. I led the conversation around to his feelings about smoking being a sin, and smoking causing his cancer. He said he knew that his cancer was his own fault. I made a suggestion that ministers need to remember that when Jesus said, He forgives all sin, that He meant the sins of ministers as well. Herb didn't respond, but asked me for the first time to pray for him, as I was about to leave. I remember that I prayed, thanking God for his gift of forgiveness.

I never brought up the subject of Herb's marriages. He never offered any information about his and his wife's relationship. I continued my visits to his room whenever I was in the nursing home and offered my prayers for personal forgiveness whenever he would let me pray with him.

When Herb finally finished his walk through the dark valley, he was alone by choice. It was as if it would have been religiously culturally incorrect to allow another minister to share his journey out of the death shadow.

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Wednesday, August 20, 2008

Vick

His last wish was to be buried in his own land.

Vick was a fifty-two-years old Seventh Day Adventist who faced his death with reality and faith. His pancreatic cancer was running rampant when he came into the hospice program. His doctor had told him he had less then six months to live. At first he said, "No way, I'll beat this little cancer." He visited various cancer centers across the country. He got involved with their methods without any success.

He and his wife lived in a mountain resort area that was not too well developed. Deep in the woods, it lay off an old logging dirt road that was more like trail ruts than a real road. Along the way as it wound its way into the wooded area, were various home sites, comprised of different sizes of mobile homes, some that were still called house trailers, and a mixture of houses that ranged from red brick to clap board, with a few log cabins scattered about. Like many of my patients, Vick and his wife had built the homestead themselves, and it never was quite finished.

Vick was a self-taught Bible scholar. We would spend hours sharing biblical passages and praying together. He never argued with me and he never quit praying for me. His Seventh Day Adventist faith was different from mine, but we spent our sharing time on the likeness of our faith rather than the differences.

Fifteen years earlier he and his wife Beth had come down from Chicago pulling a U-Haul trailer with all their belongings. They quickly adapted to the culture of North Georgia. They were involved in a three-member church. The "big church," as they called it, had a minister that disagreed with some of Vick's theology. The pastor asked Vick and Beth to find another place to worship because of the disagreement. So he and Beth started their own mission, which consisted of, Vick, Beth and a friend of theirs who left the big church.

When I met them, their meeting place was a small utility building on the edge of their property in the woods. In this church they practiced what they preached and believed. They opened their home to the homeless and those who were in need. They were good neighbors, even when they were walking through the dark valley of death. Vick once told me that the valley of death was the valley of hope as far as he was concerned. Indeed he saw the light of hope as he looked down the dark valley past the wearisome shadows.

I had just returned from a vacation trip and happened to stop by to visit with Vick and Beth earlier in the day than I normally came to visit. The dew was still fresh on the grass and shrubs. The morning coolness allowed me to ride with my jeep windows down. Several deer crossed the road as I turned into Vick's driveway off of the logging road. I noticed the freshness in the air as I parked my car and opened the door to get out.

I walked slowly up the path to the two-story unfinished house above the workshop. When I came up the steps to their little apartment, Beth came out of the workshop just below me. Looking up at me as I stood on the second floor porch, she announced, "Vick's dead." She came to the railing and stood at the bottom step. Calm and gentle, she continued, "He died early last night, or maybe this morning." She saw the shock on my face, but went on talking. "I was in the basement, getting him ready for his burial."

I knew that Vick wanted to be buried on his own land; he had picked out his plot, a grassy, level spot at the bottom of a small hill at the end of his property that was shaded by an old oak tree and some large white pine trees. Beth at first had a problem with the thought of her husband being buried in the front lawn; her daughter was out-spoken against it, claiming it was against the law. However Vick had researched what he would have to do to be buried on his own land, and found it could be done with little restriction: the burial plot of land could never be sold because it became county land when a body was buried in it. Also, he didn't want to be embalmed. This, too, was possible in North Georgia, as long as one was put in the ground within twenty-four
hours after death.

Beth came up the steps to me and shook my hand while we stood on the porch, saying to me, "I was painting his pine casket that a friend had made in Florida and delivered earlier this morning." She went on to explain saying three friends had come over at three this morning and dug the grave. "See, it's right over there." She pointed to the spot that Vick had showed me a couple of weeks ago. "The burial will be at ten o'clock. You will be here, won't you?"

"Of course," I answered. "Is there anything I can do?"

"No", she said. "The neighbors and friends are taking care of everything."

We talked briefly about her friends and her daughter and about how Vick loved his land and wanted to be buried on it.

I told her, "I'll be back before ten." I drove out of the woods and stopped by a gas station and phoned the office to tell them about the funeral and about my change of schedule for the day.

Around nine-thirty I drove up to Vick and Beth's house. There were cars and pick-up trucks parked everywhere. I was having difficulty finding a place to park; I feared getting off the road, because it had rained that morning after my earlier visit. The road was wet and muddy and the ground around the house was soggy. Someone appeared in front of me and signaled me to park right behind an old pickup.

Twenty or thirty friends and family members were standing around in little groups talking in low voices as they waited for the burial service to begin. Beth had told me that Vick didn't want a formal service. This was indeed an informal funeral in a very informal setting. A Korean woman, whom Beth and Vick had befriended years ago, had showed up and wanted to sing a hymn. There was also a minister friend who was planning to have prayer. Beth came to me and said, "You're going to say a prayer too, aren't you?"

"Of course, I'd be honored," I answered.

At ten o'clock, the sun came out. The thunderstorm had passed. Vick's friends, Beth and her daughter gathered around the freshly dug grave in the yard. Four friends carried Vick's casket out from the garage to the gravesite. The paint was not quite dry, but that did not seem to bother them. As they placed him over the grave, another friend started to read the twenty-third Psalm, "Yea, though I walk through the valley of the shadow of death I will fear no evil." After the Psalm was read, the Korean friend sang a beautiful hymn of faith. The minister friend stepped forward asked me to pray. After my prayer he and three other friends helped lower Vick into the ground. The minister prayed as he took the shovel and started putting dirt over the grave. Each of us took our
turn and shoveled the earth that Vick loved so much over his wooden casket. The people gathered around Beth and said their goodbyes, hugging and kissing her on the cheek. After I said goodbye to Beth, I drove out of the rutted road and down to the highway. I thought I could hear Vick say, "God is with me, His rod and staff comfort me."

That spring when I made bereavement visits to Beth, I drove down that same rutted road. As I came to the turn in the road that gave me a view of the home, I saw in front of me Vick's gravesite with a marble marker showing his name and dates of his birth and death. There was a beautiful flowerbed and small arbor setting snug against the mountainside, under the tall oak trees. He was resting in peace and Beth was pleased that she had granted his wish.

The death wish of a loved one is somewhat a country custom that speaks to the culture of that country. Some of the wishes come from folklore; some, from fears of the grave itself. Some come from nowhere in particular.

Vick's life taught me a lesson on personal and religious country values. He valued his faith, his land, his family and his friends. His wife and his friends valued his wishes. His religious friends honored his wishes for an informal burial, down to the pine box. Faith and religion and keeping one's word are important aspects of country culture.

The local ministers who pastor country churches are mostly bi-vocational. That is to say, they hold down regular weekday jobs and religious pastoring job on the weekends. Often times the church only meets every-other Sunday or once a month for preaching, with Sunday School held on the off "preaching days."

The pastors are a vital part of the community support system. Most of them are men of faith, Bible reading, shouting gospel preachers. However, there are some that come up short on the pastoral care end of their ministry when dealing with their members who are in the dark valley of the shadows of death. Vick's former pastor, the one mentioned earlier that dismissed Beth and him rather than practice the love that he preached, was unable to minister to either Beth or Vick.

I have worked for two hospices' over the last seven years. As best I can remember, I only received three or four referrals for admission to hospice from any
pastor. I have contacted well over two hundred and fifty churches throughout the areas our hospice serves. Only one church invited me to come and speak about hospice. I talked to my own town and country pastor. He is a seminary-educated, full-time paid pastor who is serving a country church. I asked, "Pastor, how is it that I hear you read the prayer list every Sunday morning in church with four or five members on that list that have cancer and yet you never have given me a single referral for hospice?"

"Well," he answered, "You know we pastors have to bring hope of getting well to our members. To recommend hospice is like saying God won't provide a miracle of healing if we show that we don't have faith."

I attempted as best I could to explain to him that hospice offers hope, the final hope. The ultimate miracle of God often comes when He takes His children in His arms and removes them from the dark shadows of death when they suffer with a disease like cancer, with all its pain and suffering and brings them into His presence where they have a new beginning.

Perhaps my pastor was right; most pastors I grew up with did not face their own death very well and seemed to see only death's dark shadows. For many years I too didn't think of the prospect of my own death. As I indicated earlier, it was Colby who reminded me of the lesson I learned in Vietnam and had forgotten: to keep my focus on my own death.

The ministers that I had the privilege to minister to in the hospice seemed to have a religious cultural pattern, which feared death. Having worked in two hospices situation my experience is limited and I am not suggesting that all ministers have such fear. What I learned from my ministering to ministers, who were in the hospice program as patients, was that ministers are like most people in need of God's love and the love of those around them. They, for the most part, know that they have to pass through the same dark shadowy valley of death like every one else that is facing their ending and heading toward their new beginning. Like many that face the prospect of their own death, they don't want to discuss it, hoping that by not talking about it, it will some how go away.

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Saturday, August 16, 2008

Mama Rose

Women with mountain faith and belief systems

Nurse Mack, as his patients liked to call him, received a call at two in the morning from the oldest of Mama Rose's ten children. "Mack, I hate to bother you so late but Mama has gone. You said to call at any time, so I'm calling."

"That's ok, I'll be there as soon as I can, in about forty-five minutes," responded Mack. As he hung up the phone, he could hear the family singing in the background, "Amazing Grace How Sweet the Sound."

Within fifteen minutes Mack had dressed in a hurry and was driving his big red dodge truck heading north in the darkness of the early morning into the North Georgia Mountain country. Mack had been with hospice for four years. Starting out as an aide, he had worked and attended college. Since finishing nursing school he was a hospice nurse and team leader.

The warm, moonlit night made the drive easy and comfortable. Mack had time while driving to reflect on Mama Rose and her family as he sped toward her little cabin. Mama Rose had lived in a small log cabin alone for over five years since her husband of fifty-two-years passed on. Her children lived near by, working in a marble factory and sawmill in North Georgia since their Mama got sick with "that cancer" as they called it.

The children took turns staying with her and helping her through the shadows of the dark valley of death. There was no telling how many grandchildren and great grandchildren she had. There were pictures hanging on every wall and on every table. When Mack visited Mama Rose, there were always several little people running in and out of the cabin.

Pulling off the blacktop two lanes onto the dirt excess road, Mack found the driveway to the cabin. Winding up the hill where the tall pine trees and the hardwood oak trees along side of the road made a tunnel-like approach to the cabin. Past the well-kept family cemetery that looked spooky in the early morning moonlight, he came to what resembled a used car lot. Pickup trucks, big old cars, and small cars were parked everywhere. He found a parking place behind the old chicken house that had been vacant since Mama Rose's illness.

As he opened his truck door, he heard singing coming from the lighted cabin. He smiled to himself, knowing that Mama Rose ruled the homestead and attended her Baptist church, where she loved to join those all-day singings and inner-on-the-ground services. When her illness prohibited her from attending the services, she made sure that her children took her place.

He thought to himself as he stepped up on the little porch with its rusty tin roof, I never called her by her married name, she has always been Mama Rose. As he was about to knock on the screen door, he heard the refrains of her favorite hymn, "Just a Closer Walk with Thee", filling the tiny living room were Mama Rose's bed was placed. Looking in, he saw family members, including grandchildren and great-grandchildren as well as neighbors, clustered around the bed, holding hands and singing, swaying as though they were at one of Mama Rose's all-day sings.

Mack entered the crowded house. When they saw him, they invited him to join in the singing. He excused himself, saying, "Let me first pronounce Mama." He came to the bed and took her thin wrist and felt for a pulse. He always had difficulty with finding Mama' Rose's pulse. She was snug in her bed, with a quilt that she had made pulled up to her wrinkled and stubborn chin.

One of the pronouncing customs that Mack had developed over the past year was to talk to the patient as though they were still alive asking permission to examine them for the last time. He placed his stethoscope in his ears, pulled the quilt down a little, exposing the top part of her bonny chest while he whispered "Mama Rose, I'm just going to check your heart for a moment."

"Ok, sweety," she whispered back

Mack, in complete astonished surprise, stood straight up, and stopped the hymn singing with a slow southern accent, "I'll be damned!"

No one noticed the curse word that Mack let slip. They began praising the Lord thanking Him for the miracle that had snatched their Mama from the dark shadows of death. Mack tried to explain that Mama was indeed weak, and close to death, but her spirit was still with her. However, the family of faith with their old-time mountain religion believed it was a miracle.

When Mack reported his experience to the hospice team at the next meeting, there was some good old therapeutic belly laughter all around the table. When the
laughter came to an end, he smiled and said, "I really learned one thing about these country folks. They have a strong faith and believe in the power of prayer and hymn singing as well as down right miracles."

Maybe the hymn singing and the prayers did bring Mama back from the shadow of death for one last time with her family. We'll never know. Mama Rose died three
days later and was buried beside her husband in the family cemetery.

The country faith culture had brought a great deal of comfort to the family and to the funeral preacher, who shouted his message while wiping his forehead with a white hanky, declaring at the peak of his voice that he was sure God had granted her the three day reprieve so she could witness of her faith in Jesus.

The mountain folks have a strong faith and belief system that sees them through the dark shadows of death and proceeds to assist the family through their time of bereavement. Their old fashioned way of grieving has a healing effect on the family and the community.

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Chapter 2 - The Importance of Culture Values

Job 8:8-9 (ESV)
8 "For inquire, please, of bygone ages, and consider what the fathers have searched out. 9 For we are but of yesterday and know nothing, for our days on earth are a shadow.
It matters not where you were born, Yankee, Southerner,Westerner, or Easterner. It is not the place or country, Near East, Far East, North America, South America or European. It's not whether you're rich or poor. You may be a Christian, Hebrew, Islamic, Mormon, Hindu, Buddhist, or a member of a Jim Jones Cult, or some other religious or ethnic community. All will some day walk through the "Valley of the Shadow of Death."

The unique aspect of that walk, and major difference between the sojourners on that path, is their culture. Black, White, Brown, Yellow, Red or whatever skin color will not keep one off that path. Culture will not keep anyone out of the valley or off the path of death. A person's culture will accompany those along the way to their new beginning, and provide lessons for all those who share the journey and walk down life's path.

There are many seemingly strange, dark shadows and unusual learning experiences or happenings depending on family practices and customs when that family walks into the valley with one of their loved ones. A hospice nurse serving a mountain religious family member who was struggling through the valley of death reported one of these learning experiences.

Hospice nurses are allowed to pronounce the death of hospice patients who die in their homes. This saves the family of the diseased from having to have the county coroner come to the home when the death occurs to investigate the death. It also eliminates the need for an autopsy. It is an opportunity for the nurse to start closure with the family and to begin the bereavement phase of the hospice program.

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Wednesday, August 13, 2008

Doug

When why turns to when, a lesson concerning death is learned.

Doug was too weak to get out of bed when I first met him. He and his wife lived in a trailer house in the back woods of Louisiana near one of the swampy bayou. He was dying of colon cancer and had been a hospice patient for the past four months. His bones were held together by pale white skin. You had to look twice to see where his hairline began and if he had eyelashes at all. Over a short period of time I got well acquainted with him and we became close friends.

I would talk to him about various topics such as his past work, a limousine company owner with a fleet of two long white limousines. We talked about his hobbies, fishing and frog jigging in the swamps near his trailer. We also talked about his religious background. He was a 'twice a year Roman Catholic.' Attending church only on Easter and Christmas.

We talked about his feelings concerning his cancer and even about the Ensure he had to drink for nourishment. His wife would sometimes freeze the drink so he could nibble on it, when the weather was so hot and the air conditioning didn't do much good.

Doug had been a serious person all of his life and never did anything that could be considered spontaneous. He, like most of us had looked forward to his retirement years. He and his wife invested their savings in a large RV (RecreationalVehicle) in which they planned to tour America and live out their "golden years" on the road.

They planned driving into the mountains of the West and East and even had a plan to visit Alaska. As the retirement day approached, they purchased a fine Travel Home, more than an ordinary RV. They called it their "rolling mobile palace." They had their maps with each route lined out with a magic marker. He smiled when he told me "it drove like a dream."

"Oh," I said, "You've taken some trips all ready?"

"Not really, we just drove it over to Gulfport for a couple of days, sort of a shake down cruse." Then, with a sigh that sunk deep into his bony chest where each rib stood out like a Halloween skeleton, he continued, "That was the only time it's been out of the yard."

Our conversation stopped there, simply because I had nothing to offer by way of comfort. With a deep sadness I left his home, walked past the "Palace on Wheels", and went on to my home where I wished I had a dog to kick.

On, my very next visit, which I was hesitant to make because I was unsure of what I could do or say to comfort or to help Doug, I was thinking to myself as I drove up to his house and saw the "Palace on Wheels." What in the world can I say to help him find some sort of peace and a sense of accomplishment in his life now that he was living in the shadows of death? I thought to myself, maybe I should have waited a week or so before I came out here again. But, I'm here now, so I guess I'll get this visit over with.

I mustered up the courage to speak to Doug about his anticipation of death. He readily talked about his expectation, his fears and his one regret, that he wished he had spent more time on spiritual growth and getting to know Jesus, so that he might be more comfortable now. I ventured and asked him what I thought would be a difficult question. "What kind of advice can you give me that I could share with our hospice team, now that you are face-to-face with your own death?"

As I left the trailer passing by the "Palace on Wheels", Doug's last words resounded in my mind, a lesson for my own life. "If there is something you really want to do," he said, "don't wait. Just do it!" That's the message from Doug. It came long before the Nike commercial that says, "Just do it!"

Asking questions from those who are passing through the valley of death is a learning experience in itself. Bubba answered my question with a question, which
made me aware of my own dying process. We really do not know when we will get to our own shadowy valley. Doug answered my question to him with another personal thought provoking and inner look at my own life and death. If there is something I want to do, I had better "just do it."

When we are getting along on the road that leads to the shadow of death we will see the shadows and when we do see them we need to look ahead to the small point of light that is shining at the end of the darkness. Doug saw that light at the valley's end and that gave him the strength to walk through the shadows.

When one is in that dark valley or walking with someone who is in that valley, questions search for meaning. As the shadows get darker, the questions become more difficult. A hospice staff person can feel the question coming. It sometimes comes from a patient and sometimes from the family members, often from both. It's a question most of us have thought about, but hesitate to voice in the presence of others. It was the question that Doug and his wife asked me.

It was a question that comes sometimes after the 'Why's' stop, and the 'When's' question comes into the "accepting arena." The caregiver is exhausted to the point of burnout and, the Care-Receiver is struggling for life at each breath. That deep question emerges from the darkest shadow of the valley. With a sigh of resignation the patient and caregiver alike will ask, "Someone, please tell me, when will I die? When will my loved one die?"

That question causes flashing thoughts to go though my mind. Should I tell them, not to worry about that now? Shall I say, "You need to rest", or "Only God knows? It's in His hands now. Eat something, and you'll feel better. If you're in pain hospice can fix that. No one knows for sure. I don't understand. What makes you ask?" If I were as sick as you and hurting as much as you; or, if I were your caregiver and beginning to get tired of watching my loved one die, tired of managing pills, blue pads, enemas, Ensure, straws in water, watching in-put and out-put, counting breaths, I too would want to know, when this burden would be over for my loved one and me.

The answer is not found in a cliche? like, "Don't worry about it." There is really no answer anyone can give to comfort and inform a dying patient and their caregiver. To answer the when question with, "It may be in a day or two," can bring unfulfilled hope if on the third day they wake to the same pain. The answer "any time" leaves one anxious with days and dates getting mixed up with family communications.

Caregivers need to know the answer to when question in order to call out-of-town family and friends. To make arrangements for, you know what. To have the answer to the "when" question would be helpful in making future planning, but, in truth, no person can tell anyone the correct answer.

When the whys of a patient or caregiver turn to the question of when, there is no answer that will be truthful and comfortable. The dying process does not pay any attention to one's need for an answer. The body may go on automatic into a low running mode and only it knows for sure when it will come to its journey's end. That tired body will not attempt to inform the soul that it chooses to linger.

When why turns to when, a lesson can be learned. Death, like life, has its own timetable for whatever reason. Those who ask "when" are voicing the mystery of life. The elusive answer will only come at the last breath when one takes those final steps out of the Dark Shadows of the Valley of Death into the Eternity of Light.

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Monday, August 11, 2008

Vada

Her dream was to live in a clean new home.

Vada was one of those country women who were not afraid of anything including death. When I first met her, I asked her, "How are you doing, now that you are admitted into hospice care?"

Her answer was that of a person who accepted the truth of her own death. "I'm going to die. I know that. It may be tomorrow or it may be next week. Only God knows for sure, ain't no doctor or hospic (sp) that can stop it from coming. There's just no telling. When your time comes, your time comes. Can't do anything about it, no-how." Then she smiled and said, "You just gotta be ready."

I thought to myself with a smile, "Hospic", I haven't heard that mispronunciation of hospice since moving to Georgia. A lot of Louisiana Country folks, called hospice by strange names, such as hospic, or hostage, or hostile.

Vada became a hospice patient suffering from Chronic Obstructive Pulmonary Disease. She had become weak and unable to move about, except to walk around the outside of her house, which she tried to do at least once a day. She told me, it was a good thing her house was so small or she couldn't make it around the whole place. She would take her walk early in the morning, leaving off her oxygen for a short period of time. By the time she returned from her exercise lap she would be shaking and sweating and would have to lie down and rest for several hours before she could get up again.

Her little rented house was a frame, wooden two-bedroom place, painted bright yellow. It sat off a secondary road; up a dirt driveway and under two giant oak trees whose large umbrella-like branches covered the whole yard both front and back. I sometimes worried that Vada might trip over the big roots that protruded out of the ground and ran across the yard. Some of the largest roots were threatening the foundation of the house.

Vada was a strange looking woman. She reminded me of Popeye. Her cheeks were puffed out and she couldn't wear her teeth, so her lower gums curved up almost touching her nose. She would sit up on the edge of the bed, with her thin bony legs dangling off the side. You could see she was bow-legged. When I did get to watch her walk a little, she had a swagger and a little limp.

She was only fifty-five years old, but the years were hard on her and she looked much older. Her husband was missing from the home. She told me he walked out the door three years earlier. She hasn't seen nor heard of him since.

Two of her grandchildren lived in the house with her. One was sixteen and the other had just turned eighteen. Both had little babies. One was in diapers and the other needed them, but ran about without anything on most of the time. Vada did the majority of the baby-sitting while the girls were working or looking for work.

Neither of them could hold a job over a month at a time. The sixteen-year-old had a husband but, he was in the county jail for armed robbery. The eighteen-year-old had a boy friend, the father of the little one but, he left the state and moved to Alabama. That was the last she heard of him. Vada said, "He's probably living with my old man."

The grandchildren were the primary caregivers, but the "care" was lacking. The ironing board was never down. Piles of clothing that needed washing lay on the floor. The sink was always full of dirty dishes. The garbage cans always sat on the back porch full and stinky of dirty diapers . Vada's bed was always in disarray, and her sheets were stained gray.

Vada never complained. "I won't be putting up with this mess very long when I die," she said, "I'll be in a much better place prepared by Jesus himself." She was not a church-going Baptist. Her faith was simple and to the point. "When God wants me, he knows where I am."

There are some patients that tell me that they do not fear death. But I get the feeling that they are saying that for my benefit as a minister rather then to express their own true feelings. Some, I believe, are saying they are not afraid to die, hoping to convince themselves. That was not true for Vada. I felt all along that she didn't have any fear of her own death. Looking at her surroundings, I couldn't blame her for wanting to go, the sooner the better.

Vada passed through her shadows of death and looked them in the eye. She did not fear the shadows nor did she fear the valley. She looked forward to her ending, knowing that it was a process that would bring her to a new spiritual beginning.

I was talking to her one day, and asked, "Where did you get your fearlessness about your death?"

She replied, "I can't remember just when. I've always felt this way."

"Is there anything at all that you fear about dying?" I asked.

"I fear for my grandchildren, and I wonder what will happen to my pet spider." (She had a giant tarantula spider that she would play with sometimes.) She let out a laugh. "No one will want it, so I guess it could be buried with me." Still laughing, she showed me the spider, which she had in a small cage on the little night stand next to her bed where she could feed it and give it water.

North Georgia gets a variety of weather. Although it is not near the Gulf Coast, at times the hurricane winds reach the foothills of the mountains. One evening in September a hurricane out of the Gulf of Mexico sent some strong winds all the way up to North Georgia. The storm lasted all night with tremendously high winds and inches of heavy blowing rain, causing the electricity to go off and flooding the lower land. The next morning I went to visit Vada to see how she fared during the storm. She didn't. Or should I say her house didn't.

As I drove up the driveway I saw that one of the giant oaks had crushed the house. Its massive branches had cut the house in two. The road was muddy and puddles of water stood everywhere. It was still raining lightly. I beeped my horn to see if anyone was still inside the house, but I was sure that no was at home. The house was in a mess. One end where the bedroom once stood had been crushed to the ground. I felt sure someone must have been hurt when that tree fell. I called in and reported to the hospice office before I drove to the local hospital.

When I arrived at the hospital I asked the admission office which room Vada was in. The clerk said she didn't have any patient named Vada. I mentioned that her house had been destroyed by the previous night's storm. The hospice hadn't heard from her and I was worried about her. The clerk asked a passing nurse if there was any patient fitting Vada's description brought in the night before.

"Oh," said the nurse, "that must have been the woman who lives in the yellow house on the hill off of old highway five. She was in last night after her house was demolished. She wasn't hurt, so we released her. She went to the shelter at the First Baptist Church."

"Thanks," I said and hurried off to the church.

I arrived at the church but, the shelter was closed. I talked to the church's secretary who told me that there had not been enough people to keep the shelter open. They had no idea where Vada was staying. They weren't even sure if she had spent the night in their center. I called our hospice office and they hadn't heard from her either. Where was Vada?

The next day Vada called the office. She was staying with her sister-in-law, Fran.
Fran heard about the house being destroyed and found Vada and took her in, spider and all. She lived alone in a small apartment, directly across the street from the funeral home. Fran knew about hospice because her first husband had been a hospice patient who had died in the program two years earlier.

I went to the apartment to visit with Vada and renewed my acquaintance with Fran, who now became Vada's primary caregiver. Vada told me that the kids were alright, that they were staying with friends.

She went on to say, "It was a miracle that no one was killed in the house. During the storm my granddaughter got up around 2:00 am to check on her baby who was in another room. When she picked him up, the tree fell, right over her bedroom, completely destroying and crushing it." Vada was convinced that God blessed them and was looking out for her and her children and the grandbabies.

I visited with Vada and Fran every week for the next month. Vada was attempting to find another place to stay because Fran's apartment was too small and Fran's nineteen-year-old son kept coming by to spend the night and slept on the couch. He introduced Vada to one of his friends who said he was renovating a doublewide mobile home and he would be willing to rent it to her when it was finished.

Vada had a dream of living in a nice place. She was determined not to allow her kids and her grandchildren to move in with her and mess it up. I asked her one-day, "Who is going to be your caregiver, if you live alone in the trailer?"

She said, "I'll figure that out when the time comes." Then she quickly added, "If the time ever comes." The friend was dragging his feet on the renovation, and it was going to take much longer than anticipated. Every visit, I heard the same story, "It will be just a little longer."

Vada never lost hope of moving to her new home. Months passed and her hope became a Christmas wish. Her health was getting a little worse with time. She and Fran continued to get along with each other. Fran enjoyed her company. Vada was happy about the present arrangements except for the son who visited almost every night, taking over the couch in the small living room. She kept telling me that she was sure that she would be moved into her new home before Christmas.

December 23, hospice received a call from Fran, "Vada died that night around midnight. Her son had just come in the apartment and found her on the living room floor, dead." He called 911, but it was too late. Fran said, "Vada is at the funeral home across the street. The funeral would be the day after Christmas."

Hospice was not notified until well after the fact. Our staff, chaplains, aides, social workers and nurses were all out visiting our patients for a pre-Christmas visit to bring them gifts that our volunteers made for them. The secretary for hospice knew that one of our nurses was scheduled to visit Vada that morning. She immediately paged him to tell him about her death. His pager was not working for some reason.

The nurse reported the event at the next team meeting as one of his most embarrassing episodes in his young nursing life. He had forgotten to turn his pager on that morning. He had made several visits to his patients, who were in the shadow of death.

He reported, "I was feeling quite good. Most of my patients were in good spirits and loved the gifts from the volunteers. I was playing Christmas carols in my car as I drove around, feeling a little of the Christmas spirit. I stopped at Vada's apartment, and noticed a lot of cars across the street at the mortuary. I thought to myself, too bad for that family, it's almost Christmas." He went on, "I went to the front door and knocked.

It took a while for someone to answer. Fran's son opened the door. I asked, if Vada was up and said I had a present for her."

Wiping the sleep from his eyes, the son drawled, "I don't think so." Pointing across the street to the funeral home he said, "She's over there. Go and see for yourself." He learned his lesson in patient care: always have your beeper turned on.

I was visiting another patient when the secretary paged me. She told me that Vada had died during the night and her body was at the funeral home. I told her I would go on over to see what was going on and offer my condolences on behalf of the hospice.

I was about twenty minutes away from the funeral home. As I drove, I began to think about my relationship with Vada. I remembered her early statements about not fearing death I also remembered her looking like Popeye and laughed to myself about that image. I remembered her comments that she would be out of that mess someday.

Then I recalled my recent visits. She talked about her new doublewide and how wonderful it would be to move in at Christmas time. She had dreams of moving into a clean place that had plenty of space where she wouldn't be a problem for anyone. She told me, "My spider and I will really love it." On my last visit she said that even if she didn't get to move in by Christmas, planning the move was half the fun.

As I drove into the parking lot at the funeral home, I couldn't help thinking that she is no longer in the dark shadows of death, she has indeed moved to a much brighter place than a doublewide trailer. She was in her own place that God had prepared for her. I smiled to myself; I wonder what happened to the spider?

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Friday, August 8, 2008

Bubba

An old Merchant Marine asked, "How do you know I'll die before
you?"


One of the first lessons I learned from those who are walking in the shadows of death came from my first hospice patient. He reminded me of a truth that I had forgotten in my zest for work, ministry and life. That truth was that we really do not control our own dying process; we do not really know when we will die.

A person desiring to be a hospice patient must be admitted by a doctor who will state to the patient and family members and be willing to note in the patient's medical record, "The patient has six months or less to live if the disease follows it normal progression."

I have not met a doctor who will give a definitive interpretation of what is a normal prognosis for his patients he believes are dying. Each person has within his cultural background various energies and life and death experiences that need to be taken into consideration when he is being diagnosed and facing their own death.

When a person undertakes the awesome task of assisting and comforting a dying patient, he must remember that he too is dying with each breath that he takes. Death is no respecters of persons. That old adage, "The only certain things we face in life are death and taxes'', may only be half true. Our taxes may disappear or we might choose jail rather than paying them, but death leaves us with no choice. Our own death will be a part of our life experience, whether we want it or not.

Bubba was a partially blind widower, an eighty-five-year old retired merchant marine chain smoker that had cancer devouring his lungs. His closest friend was Roger, his pet parrot, whose few choice words were off the deck of Bubba's old merchant vessel. He lived alone with his paid caregiver and was handling his cancer as best he could. He was my first hospice patient in a small hospice in Louisiana where I had become its first Staff Chaplain. Bubba was facing his death, his walk in the dark shadows, in the gruff "man of the sea" manner.

He became my first hospice patient teacher as he taught me my first lesson from the shadow of death. Bubba didn't like to talk, especially to ministers or chaplains. He attempted to set me straight on my first visit with him when he said, "I don't feel like talking." Then he wanted to know, "What in the hell are you doing here?" I told him, "I'm working for the hospice and you're my only patient at this time. I need to visit you at least once a week so I can get paid." He smiled with a twinkling gleam in his eyes said, "Ok, I guess but, I won't talk much."

For the most part he kept his promise. Our conversations would be short and one sided. I did all the talking. He sometimes shook his head while his parrot sat next to him and cussed at me from time to time, making Bubba laugh. One afternoon I learned from his caregiver that Bubba liked to sing conversations rather than just speaking. So, on my next visit I attempted to sing my greeting, "Bubba how are you doing today?" I sang. To my surprise Bubba responded in a weak singing voice, "Not so good. How are you?" This went on for a few brief minutes during our visit. Our singing seemed in some strange way to create a bond between us.

Neither ofus could sing very well and we were both a little tone deaf. One day we sang together, "Jambalaya eye crawfish pie." When I found out that his wife who died three years earlier was Baptist and her name was Grace I sang "Amazing Grace" to him. Whenever he heard that hymn, he would get tears in his eyes and make an attempt to join in the singing. As Bubba began to realize his death was getting closer he would sing, "I'm off to meet My Maker." Other times he would sing about the doubts he had as to what was ahead for him.

On one of my visits I was trying to get Bubba to open up and talk [sing] about the new beginning that was waiting for him when he died. I sang to him, "Bubba when you get to heaven and meet the saints will you send a message back to me and tell me what heaven is like?" He sang back his response with his weak and shaky singsong manner, "What makes you think I'll go before you?" That was my first and lasting hospice lesson from the Valley of the Shadow of Death, one of many that my patients have taught me over and over again. "I don't know for certain the time of my departure from this world by death, only that I should be packed and ready for my new beginning."

Ecclesiastes 7:1-2 (ESV)
1 A good name is better than precious ointment, and the day of death than the day of birth. 2 It is better to go to the house of mourning than to go to the house of feasting, for this is the end of all mankind, and the living will lay it to heart.
When I left Bubba's home I drove out onto Interstate Highway 10. As I pulled into the traffic, a large sixteen wheeler almost ran me off the road. After the shock of his air horn, I thought about Bubba's last song to me, "What makes you think I'll be there before you?"

I have learned a lesson that goes with me in working with hospice patients like Bubba. If I want to walk with patients through their shadows in their dark valley of their death and assure them of a new beginning, I must be aware that I'm facing my own death and anticipating my own new beginning.

When you're walking through the valley of the shadow of someone else's death, you learn how to live your life in the light while you have it. Their dark valley can be a classroom for living. Their dark shadows can be lessons in how to live.

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Wednesday, August 6, 2008

Chapter 1 - The Importance of Facing One's Own Shadow of Death

Psalms 102:11 (ESV)
11 My days are like an evening shadow; I wither away like grass.

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Colby

An Army Green Beret with a tumor asked, "Have you ever thought
you might die?"

Colby was a twenty-four-year-old hospice patient suffering from a tumor behind his left eye. He was in training to become an Army Green Beret when the tumor was first discovered. An aggressive individual, he did not understand the word quit. He hadsought out all the various cancer treatment protocols the very best military and civilian hospitals could provide. After nearly a year of intensive treatment, the Army sent him home to get his life in order. Colby was going to die. Part of getting his life in order was coming into the hospice program.

Some days he seemed to be handling things in his combative fashion, and other days he would go into a shell of passive, dark silence. He would lie on the sofa and drag his hand on the floor so his old dog, Randy, could lick his fingers.

As time went on, Colby became less and less active. He began to spend more and more time with Randy at his hand. On one of these dark days in his valley, I attempted to bring in some shades of light. We had a connection, because of my being a retired Army Chaplain. There were days when I would be able to share my war stories with him and he would kid me about being an officer protected by the enlisted grunts.

Today, he didn't want any small talk. He was drifting in and out of a weary sleep. His medicine was keeping him free of pain, but unconscious most of the time. Randy was lying by his side, allowing his master's hand to rest on his back. I had an agreement with Colby that if he didn't want to talk, I would just sit by his side for while. This was one of those sitting days.

After a little time he woke up for a minute. "You still here, Chaplain?"

"Yeah, I'm watching your dog enjoy your touch."

"He's a true friend," Then he seemed to go deep inside of himself and in whispered voice he asked, "Have you ever thought that you might die?"

I took a moment to let his question sink in, but before I had a chance to answer he drifted off to sleep again. My thoughts also drifted back to one of my first war stories, one I had not shared with Colby.

I was back in Vietnam. February 13, 1970; it was my first visit to a firebase since coming to Vietnam. Firebase Warrior. My commander was going to be leaving on permanent change of station (PCS) orders on Valentine's Day. We had a big change of command party for him that night. It was a great parting feast; steaks, wine and ice cream and even folk songs written and sung by one of our troops. The Division band was scheduled to arrive the next morning to participate in the change of command.

I was bunked down with a private called Speedy who had space enough for one more to sleep in his bunker. The party was over about ten o'clock. I hit the sack on an air mattress that I had to crawl on, because the bunker was only four feet high and seven feet deep. But, as Speedy said, "It's a safe hooch with two layers of sandbags over
head."

I woke up at two in the morning to use the latrine. Speedy was snoring gently. I crept out to find the "pee tube" which was a pipe hammered in the ground, next to the dump. When I got back, Speedy was awake. "Should I take my boots off?" I asked.

"Chaplain, I wouldn't. You just don't know what might happen?"

He was more of a prophet then he knew. I was almost back to sleep, hoping to dream of home when the world around us began to explode with vengeful force.

I pulled back the split sandbag sack that served as the bunker door and looked out across the firebase. Blasts of orange explosives shouted out their disruptions like thunder and lightening coming from the earth upward into the dark, overcast night. Mortar pits were aglow with flaming orange blasts. Coming from the 105-howitzer area were loud, exploding sounds from Vietcong satchel charges blowing up the big guns. White smoke reflected a yellow tint thorough the night as flares lighting up the sky.

The Vietcong were wreaking havoc over the sleepy firebase. The command tactical operations center was as bright as sunbursts. A-47 rounds screeched though the air while bursts of M-16's answered their foes. Speedy cussed at his M-16. He had not cleaned it for three months and now he doubted its workability. Yelling at Speedy to stay put and guard the bunker opening, I started to pray. The firebase was being over-run. I truly believed I was about to die. My prayer was for my wife and my boys, asking the Lord to care for them and for the men on the base. Believing I was about to become a war casualty, in all that chaos, there was an inner peace that told me no matter what happened to me, all would be right.

Then as suddenly as the horror began, it stopped with a deafening silence. The voice of Captain Jones yelled over the bunkers across the smoking firebase. "All's clear. Chaplain you're needed at the helicopter pad."

Colby stirred and woke again. "I'm sorry, Chaplain, I guess I dozed off. I was just wondering, have you ever thought you would die?" He asked again.

"I sure have, one night in Vietnam our battalion was being over-run and I thought that I was going to be killed. I haven't been the same since. It changed my outlook on life and my approach to ministry."

Colby's eyes closed and his mouth curled up at the corners in a slight smile while his hand softly stroked the back of his faithful pet, Randy.

I had forgotten the lesson I had learned on that early morning on Firebase Warrior in the Central Highlands of South Vietnam. It was a lesson that I had to learn over and over again as I ministered to the dying. My instructors were each of my hospice patients. The lesson is simple and inescapable: everyone, including myself, will face the shadow of death.

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Monday, August 4, 2008

Robert

An Afro-American Cherokee dying of cancer taught me that cancer is a family affair and gave me the inspiration to write this book.

"I've been in this dark valley for three years. It has gotten darker and darker each day. The shadows are looming larger and larger on the sides of the steep valley walls. What started out as a journey of fear is turning to one of hope, because now I can see a faint light ahead of me. It seems to be getting larger and brighter each day. I'm guessing I will die soon and come out of this dark valley. I feel like I'll be starting a new adventure, a new beginning. I guess it will be a sort of a new spiritual beginning."

Robert was a fifty-three year old patient who had suffered in the dark shadows with his liver cancer for the past three years. His wife Debbie and his three children: Darrin (twelve), Edward (nine), and Abby (seven), walked that valley with him. He had been a hospice patient for the past five months. Recently, he had taken a turn for the worse and was nearing death. He shared his comments with me, the Hospice Chaplain, when I asked him, "What's happening?"

I learned as a hospice chaplain that asking the question, "What's happening?" opens a counseling conversation much quicker and more to the point than the tried and weary remarks, "How are you feeling?" "Good morning, you're looking fine", or "How's your cancer doing today?" No matter how miserable a patient may be feeling he will try most often to disguise his answers to trite questions by giving you the answers he thinks you want to hear.

I never expected the answer that Robert gave me that morning. Robert was half Cherokee Indian and half Afro-American, married for fourteen years to Debbie, a red-headed Irish woman, who liked to say she was Irish American, because Robert liked to tell people that he was an Afro-American Cherokee. She thought that their genetic make-up gave them the strength to survive. The next question I asked Robert was an open-ended counselor type remark. "You must feel lonely being in that dark valley."

His answer revealed the process he had gone through to get to the place where he could accept his death and look forward to a new beginning."I'm not feeling lonely at all", he said. "I have Debbie and the kids who are walking with me in the valley. If they weren't with me, I don't think I could make it."

I nodded my head in understanding, but I had more lessons I needed to learn. At that moment Debbie entered the room with Robert's medicine.

"Time for your meds, honey", she said, overhearing the last part of our conversation. Handing Robert a small pill she picks up the glass of water from the nightstand and gently placed it to his lips. "It wasn't always this easy." She said. "He was a bear when this thing first started. He wouldn't talk about it, didn't want me to talk about it. He didn't want to see anyone. He all but turned the children away because of his orneriness. They didn't understand why their daddy was so angry all the time and why he would push them away when they tried to get close to him. They began to feel lonely, just like I was feeling."

Robert smiled at her, squeezed her hand while turning to me and began to tell his story. "When I first was diagnosed with cancer, I was determined to beat it. I am an Afro- American, Cherokee Indian and stubborn as hell. As I grew up, I learned never to quit. My parents were good to me, but strict. We lived on a houseboat in a bayou outside of Baton Rouge. Not an easy life, but it was an honest one. I joined the Marines when I was eighteen, and that's where I learned to discipline myself. So, I wanted to beat this cancer by myself."

Debbie pulled up a chair and sat, holding her husband's hand. "That's what I mean. He wanted to cure himself and refused to talk to me about his feelings. He didn't want to go to the doctor, but finally he got so sick that he agreed to go. The doctor told us that he had serious cancer and that we needed to get help. He explained hospice to us and recommended that we call.

At first Robert refused to let me call your office, but finally when his children started to have problems in school, I got angry with him for his clamming up. I broke down and threw a fit. I yelled at him that he might as well die, that I was tired of pretending that nothing was going on. I was so angry I cried. Finally I said to him that even the dog was frightened by him, so I was going to call hospice whether he wanted me to or not."

She was holding his hand and gave it a little squeeze as she continued. "Those early days were difficult to deal with. We are now learning to cope by living one day at a time." My learning experience went on as I sat with Robert. All three of us were talking about hospice and how it was helping them to deal with "their" illness. They were very complimentary of the program.

Debbie said she didn't think she could have made it this far without our help. I was thinking to myself as the conversation went on. How true it is, that cancer is a family illness. That everyone in a family is involved when one of their members faces certain death.

The school bus pulled up outside the house.You could hear children's loud talk, the bus doors opening as children yelled to one another saying their goodbyes. The front door flew open and slammed three times, as each child entered. They threw their book bags on the floor and came directly into their father's room. Little Abby came bouncing in and went directly to the bed and sat next to her daddy, bending down to give him a kiss. The boys were a little self-conscious with my being in the room. They stood close to the bed, and they smiled at me as their mother said, "Say hello to the Chaplain."

"Hello", said Darrin and Edward in unison. Each of them wore a bashful smile.

Abby looking up from her daddy's side with a big grin, showing a missing front tooth,
said, "Hi!"

A strong sense of family filled the room. They were together facing the shadowy valley of death. I asked to be excused. My lesson was over for the day. I asked if they would like me to say a prayer before I left. Debbie, who was the spiritual leader of the family, quickly gathered the children around the bed, all of us holding hands as I prayed for their daddy and their family to have a restful, peaceful remainder of the day.

I left Robert and his family with the feeling that they had given me a learning experience by allowing me to walk a little ways with them through the emotions of living in the shadows of death. When I got into my car and began to pull out of the driveway, little Abby was standing at the door waving good-by. My Bible was in the passengers seat, opened to Ecclesiastes. I stopped before pulling back onto the street, picked up the Bible to close it and put it away. I glanced at a passage I had highlighted in the past.


Ecclesiastes 3:1-2 (ESV)
1 For everything there is a season, and a time for every matter under heaven: 2 a time to be born, and a time to die; a time to plant, and a time to pluck up what is planted;

The reality of death teaches us to live. I have had the privilege to assist the dying as they approached their eternal spiritual beginning. Their cycle of life on earth was coming to an end and the excitement of their new beginning into the next cycle approached. These kinds persons become mentors and teachers that allowed me to gain lessons from their journey "Though the Valley of the Shadow of Death."

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Sunday, August 3, 2008

Acknowledgment

The very first lesson I learned as a hospice chaplain was that I was the student
and my patients and caregivers were the instructors. They have taught me the
importance of facing my own dark shadows of death. I have learned from those shadows the importance of culture values. I learned the importance of my life's work.

When I listened to their stories of personal relationships, I learned the importance of my own relationships within this dying world. My relationships with the dying also taught me the importance of spiritual and religious values. I was taught the importance of accepting the responsibility of being a caregiver to both the dying and the living. It is because of these lessons in my life that I am indebted to those patients, caregivers, as well as other family members and friends that have allowed me to walk with them in their Valley of the Shadow of Death.

When my family, friends, associates and other acquaintance would ask me what I was doing since leaving the Army Chaplaincy, I smiled, as I told them, "I work with persons who are dying." Their reaction is predictable. There is often an expression of shock on their faces. Then they say something along the lines of, "Oh, I don't know how you can do that." Or they say, "That must be so depressing. I couldn't do that." There are some, if my announcement happened to be at a party, who simply say, "That's nice," then they excuse themselves to go over to the hors d'oeuvres table.

In writing this book I have only used first names and changed those names in all my patients, except for Bubba and Peter. Bubba's name had to be Bubba. It was his first name, he was every bit a Bubba. I used Peter's name because the story would not be the same without using "Peter". With many of the patients I attempted to change some details to protect their privacy.

Some of the lessons I have learned will be obvious to most readers, and some of the lessons I have attempted to point out. I divided the book into six learning divisions or chapters. The reader will readily see that many of the lessons overlap from chapter to chapter. For instance, Chapter VI, on caregivers, emphasizes the difficulty some caregivers have with their patients and the problem I, as their counselor/chaplain, was having in trying to help the caregiver, while at the same time, trying to meet the patient's needs. There were times when such needs were at odds with each other.

One of the greatest lessons I learned from working with both patient and caregiver is primarly throughout the other five chapters. That is, anyone who desires to walk with the dying into the shadows of death, into the dark valley of the dying, will need to be a person who has unconditional love and respect for those who allow them into their lives.

I learned that acceptance of one's death may arrive by the way of anger and confusion from the family members. I learned the importance of communication among the patients family. I learned that culture and faith are important in ones journey
through life. I learned that there are more lessons that I need to learn as I walk with those who are facing death.

Many of the lessons I learned are personal to me and I hope become personal to the readers as well. It is my aim for this book to assist the reader to identify those lessons taught to them from those dying acquaintances and using those teachings to further assist others they meet in their journey through the shadows of death to their new beginnings.

There are many lessons I am still learning from those dying patients who have become my instructors in living. I am indebted to these wonderful dying persons-patients, who are no longer in this world, for allowing me to share their journey to their new beginning, at the end of their Valley of the Shadow of Death.

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