Confessions of a Hospice Chaplain

The theme of this year’s Spiritual Care Week is “How Chaplains Complete the Picture in Collaborative Health Care”. I recall with gratitude and affection the day, over 30 years ago, when I said “yes” to devote myself to this beautiful and meaningful ministry.

This week, I also intentionally remember the faces of the multitude of patients I affirmed, comforted and prayed with throughout these past three decades. It is important to remember their faces to honor them and to assure their memories continue to be eternal.

Hospice chaplains understand there are different types of pain our patients experience. It is a type of pain that cannot be treated simply by a shot of morphine. Simply put, it is soul-pain. It is the existential and spiritual suffering that for our patients is soul-shaking and soul-evoking.

Cecily Saunders, the founder of the modern-day hospice movement in the 1960’s, also had an acute awareness of the psychospiritual suffering of her patients’ experiences. She understood that hospice care could not be comprehensive unless we cared for the entire person, physically, emotionally and spiritually. Dr. Saunders recalls once asking a patient, “How is your pain?” Her patient replied, “Well doctor, the pain began in my back, but now it seems that all of me is wrong.” At that moment, Cecily Saunders had a revelation. It was the revelation that end-of-life pain was far more complex than simply physical.

Consequently, Cecily described and coined the term “total pain.” She believed this term best described the global or “total pain”, of her patients and that the assessment of total pain needed to include the existential and spiritual pain which her patients were also experiencing. It was only in this inclusive diagnostic sense that Saunders came to believe that an accurate and comprehensive pain assessment could be made. It is fair to conclude that no individual more than Dr. Saunders was a loyal and steadfast advocate for the need of chaplains on the hospice interdisciplinary team.

In my attempt to characterize a more personal description of the art of chaplaincy, we meet each individual patient on a “soul level”; a level underneath and beyond the ego and persona. In my experience, a large element of spiritual pain is that of acute mortality consciousness, the overwhelming distress of knowing that life will come to an end. This awareness literally strips the patient’s ego along with any other natural defenses of the personality that one has depended on when facing an existential threat.  

The patient then crosses over a threshold into a foreign land, one of intense vulnerability, fear and loss of control. During this phase there is often a marked shift in focus and priority. Many patients feel desperate for spiritual security and meaning in the face of illness. For others, it becomes the quest for hope and inner peace. Their spiritual goal often is a rebirth of faith in a loving God and assurances that God has not abandoned them.

Chaplains provide a sacred space and time to attend to these issues and fears of our patients. We become a soul-friend to them. We walk with and guide them out of these dark waters of despair to a new shore, one of brightness, hope and a resurrection of the soul.

Finally, I would like to end with my most meaningful example of the essence of chaplaincy. Several years ago, a patient asked me, “In one sentence explain to me what you do?” After pondering my heart for the answer, I finally replied, “There is one beautiful verse that I believe best characterizes the essence of what I do. It is the verse,  “There is no fear in love, for perfect love casts out all fear,” 1 John 4:18. My role is to join you to identify and leave behind any obstacle that would prevent you from experiencing this type of divine-unconditional love, for it truly will cast out every fear.”

This patient did overcome her fear of dying. She did experience a divine love immersion. Some of her final words included, “You know what…I now know that I’m going to be okay. I know that God and my family love me more than I have ever realized before. I’m no longer afraid to say good-bye.”

A chaplain is one part of a comprehensive team available to each Care Dimensions hospice patient. Learn more at: https://www.caredimensions.org/hospice-care/index.cfm.

About the author
Fr. Terrence P. McGillicuddy, Ph.D., is a chaplain with Care Dimensions and author of the book, Sacred Dreams & Life-Limiting Illness (Westbow Press 2013)