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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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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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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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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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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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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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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