Tuesday, December 30, 2008


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.


Tuesday, December 23, 2008


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."