Men and women of the clergy occupy a unique position. Whether ministers, priests, or rabbis, they have authority and respect in the community.
I try to accept the person as a fellow human being. As a listener, I have learned that I can create an atmosphere of solicitous permissiveness in which the troubled patient feels free to share the burden he or she is unable to carry alone.
One of their many functions is to comfort the sick, at home or in the hospital. The patients they visit in a hospital are not necessarily limited to members of one congregation, or even one religion. Some patients may no longer have any religious affiliation. Yet the clergy still can be welcome figures, sympathetic listeners, and sources of emotional and spiritual sustenance.
Many people under the stress of illness or dying call upon God to help them. Severe stress and fear may also cause them to revert to previously held religious views. For these people, as well as for regular members of religious groups, the clergy represent faith, salvation, and the authority of God. They are expected to have special insight into the mysteries of life and death.
Ernest H. Rosenbaum interviewed representatives of three faiths—Chaplain Laursen, Father Shanahan, and Rabbi Asher—to ask them how they approached individual patients and how those patients reacted. What follows is not a comprehensive discussion of religion; it is an attempt to understand the role of the clergy with regard to the patient who has cancer. In spite of the many differences among the three faiths, in both concept and practice, it was found that in dealing with the cancer patient the three clergy differed only in style. Their objectives were similar: to help people to live, and also to die. In this respect, their roles do not differ from those of doctors, nurses, social workers, or volunteers.
Father John Shanahan: There are, of course, certain expectations, somewhat vaguely conceived, of what a clergyman should do. He is expected to minister to the patient, to provide the opportunity for sacraments and prayer, to bring comfort and solace in some way, to deal with spiritual problems, to lift the patient’s morale, and to spread comfort and cheer. In the popular dichotomy, the doctor cares for the body, and the chaplain cares for the soul. The clergyman has the opportunity to make a unique and valuable contribution to the spiritual, mental, and emotional well-being of the sick, the seriously ill, and the dying.
As a priest in a hospital setting, I am, among other things, acting as a representative of our religious community. The patients don’t know me personally. They come from various parts of the San Francisco Bay Area. They are separated from their families. My being there says, “We care about you. We want you to get well. How can we help?” Maybe these people haven’t seen a priest in a long time. But my presence might remind them of a time when they attended church and thereby give them strength for the present. On the other hand, some people with tenuous ties to our religious community don’t care about seeing a priest, so my visit to them will not be supportive. Each patient reacts differently. Therefore, I don’t have a planned approach.
Slowly and painfully I have learned one general approach. I think this approach helps me, as a priest caring for the seriously ill, to listen, and I hope it has helped the patients I visit. Unaware of the dynamics behind the emotional stresses or moral disorders in a man or woman about to die, with not the faintest idea of what to say, I listen. I have learned to hold my tongue, learned what not to say. I try to show sincere interest, to reflect understanding of the person’s feelings. I try to accept the person as a fellow human being. As a listener, I have learned that I can create an atmosphere of solicitous permissiveness in which the troubled patient feels free to share the burden he or she is unable to carry alone. I try to be compassionate, to touch the emotional pulse of the patient by identifying in some personal way with his anguish, his bewilderment, his interior conflict. I try to understand. I need hardly say a word. Someone is interested; someone understands; someone is in no hurry to run, to belittle, to disparage, to explain away the worry, or to trot out pious clichés. I am, primarily, a listener whose contribution is a wholehearted acceptance of the patient. I try to create a climate in which the sick person feels he or she may speak without fear.
Rabbi Joseph Asher: I feel that my function is to try to be an empathic person who relates to people not as a rabbi but as a friend. The only rabbinic component of this kind of relationship is that perhaps the person has more respect and regard for me because he recognizes that I have seen other people in his same situation and may even have some direct communication with the divine. But I don’t. I really don’t think I have ever contributed to a person to the extent that I have evoked resources of strength he did not have before I came.
The best I have been able to do is maybe awaken resources that this person was planning to set aside or was unaware he possessed.
I may say to a patient, “Now look, every day that you live is one more opportunity for an improvement in your condition, because with medical science the way it is today, what is impossible today may be possible tomorrow.” I also explain to him or her that much of survival—and this may be impression rather than fact—depends on a person’s will and a person’s desire to survive.
Recently, a member of my congregation had a stroke and simply did not want to live. He would not participate in such therapy as was available to him and after a period of months he just died. The physician who took care of him told me that this man could have lived longer and could have lived an active life. He simply did not want to live. So what I can do, as a rabbi, is constantly reassure a patient that a great deal of his recovery depends on that person’s will to live. If I can help strengthen that will to live, I have made a contribution.
Nevertheless, I’m terribly aware of my impotence in these things. It’s very difficult for an outside force to have any effect in a situation like this. People’s lives cannot be influenced to such an extent that a person can say, “The rabbi was here and he told me I’m going to live. Therefore I’m going to live. I’m going to try harder than I did before he came in.” The person may do this for five minutes, in my presence, but if his nature is inclined toward giving up, that’s what he’s going to do.
However, I think we often underestimate both the patients’ abilities to cope and their need for comfort arising from an apprehension of the truth. We always think they need to be babied when they are in such situations. It is really more the function of the rabbi to relate to the family, to help them accept the inevitable with grace and with a certain amount of consolation. They, in turn, convey this composure to the sick person. The entire Jewish tradition teaches us to confront reality. If a person is about to die, then we have to recognize the fact that this is about to happen. We do not, under any circumstances, encourage a kind of covering up of what is about to occur, nor do we hold out a description of life beyond. That is why it’s sometimes much more difficult for a rabbi to comfort a family, particularly when a death occurs that is out of the ordinary.
In such instances, the family’s first response is often, “How could God let this happen to us? What justice is there from such a God?” I tell them that God is not doing something to hurt them. The untimely death of the person they love is simply one of the malfunctions of nature just as much as is an earthquake or a hurricane.
Reverend Elmer Laursen: Patients have fear of cancer as a disease, and they need to share their fear and anxiety with someone who will listen. Many physicians and nurses listen to patients, but a clergyman may do it in a different way. He comes to listen to their questions, which often include “Why did this happen? What did I do?”
Our objective is to support patients in the most appropriate way. We try to keep hope alive, but not to foster false hope. We share the bad times that depress patients. We try to help them accept illness as a part of their lives instead of just to fight it. We try to emphasize the positives in their lives, but when there are few or none of these it is harder to help them.
I attempt to console, share and be alongside people during their suffering. I listen to their questions in a supportive way, helping them tap and enlarge upon their religious resources. I listen, and sometimes in silence I give aid and comfort. Frequently my main function is just to be there. I try to hear patients’ verbal and nonverbal cries and concerns and, if possible, to help them achieve a new perspective. It seems to me that by sharing I contribute the important element, which is to help them feel less alone and less deserted.
When there are family members, relatives, and friends who are a part of the supportive system for a patient, I can at times also help them with their feelings and enable them to be supportive rather than hindering to the patient.
I have become increasingly aware that in our work with people and their problems, we need not pretend to have any great answers for them. They sometimes find answers for themselves, or at the least they find someone with whom they can share their questions.
While as a chaplain my desire is to work closely with the physician, he is not always ready to involve me in patient care. Often, I am able to minister effectively in spite of his reluctance to include me. However, we both do a better job when we can work together.
The acceptance of the problem of illness and the incorporation of that acceptance into one’s life and trying to deal with it is an upward process. People who learn to accept and reconcile themselves to dying often seem to live more effectively. Given the opportunity to vent their anger at God in the presence of an understanding clergyman, they may be relieved of their guilt feelings. It is normal to be angry, curse, or swear at God and ask, “Why?” Eventually they learn that they can be as angry as they wish at God because He is big enough to handle it. Then they can begin a more dynamic process of living for their remaining time. Somehow, it is helpful to most of us to be able to accept that death is a part of life.
The process of learning how best to support a patient is long and arduous. It involves going into a patient’s room, letting him say whatever he wishes, and then helping him to look at what is going on, to reflect on it. I feel it is unnecessary to confront a person too heavily or bluntly. I have better ways of being with a patient than saying, “You know, you have to take a look at this for your wife and family. You can’t just give up.” Rather, I try to help him take hold of the problem and deal openly with it.
Finally, the time arrives when all I can do is to help a patient to die graciously. In doing that, I believe I am helping people to live right up to the last moment.
Ernest Rosenbaum: The three of you have a similar concept of the role of the clergy in supporting a cancer patient. You help by supporting, encouraging, listening, empathizing, and giving both faith and hope to a patient, his family, and his friends. You absorb the anger of a patient. You can be trusted with confidences and yet you are accepting and not shocked.
Ritual is often followed in ministering to patients. Father Shanahan, do you still administer the last rites to a patient who is coming to the end of his life? If so, what effect does this have on him?
Father John Shanahan: There has been a change in the administration of the sacraments that makes them more meaningful. The Sacrament of Extreme Unction is now called the Sacrament of the Sick. It is administered frequently and quite normally when a person is ill but not about to die. Last rites is a term reserved for the use of the funeral liturgy.
Ernest Rosenbaum: Rabbi Asher, how does the Jewish ritual help people to come to terms with grief?
Rabbi Joseph Asher: As with every aspect of life, Judaism’s rituals seek to provide outlets for emotions rather than submerge them. Our tradition understands the immediate response to the crises we experience and seeks to vest them with meaning in the context of our relationship with the divine. Thus, when death comes the family’s anger and their total withdrawal is acknowledged. Certain normal religious functions are suspended. In our anger, we can hardly be expected to praise God. After the funeral, the family remains at home for seven days, desisting from its regular habits and inviting friends to come to the house for communal prayer rather than going to the synagogue. After that week, and until thirty days after the death, normal activities are resumed, while some personal habits—for which one would have no inclination anyway—are still restricted. For the ten months following, one does not engage in any activities that might be interpreted as unduly entertaining or engaging in levity. Eleven months after the death, family and friends gather to consecrate a memorial at gravesite. This ritual demonstrates the “closing of the grave,” a symbol that grief must now be set aside and we must come to terms again with life.
The most modern understanding of the grief syndrome acknowledges stages of emergence from it. Jewish ritual is designed to guide us from the most abject sorrow to renewed composure, allowing for time to bring its healing to the bereaved.
Ernest Rosenbaum: Chaplain Laursen, what extra help can a person find in dealing with death and grief?
Elmer Laursen: Workshops, seminars, and retreats for clergy and laypersons are effective in helping them express their feelings and thoughts about death and grief. People of all ages have participated in these groups. Most of them have felt threatened at first, but after permitting themselves to become involved in the dialogue and in the process of reflection, they have found that some of their fears were lessened. These are subjects that we all prefer to avoid, but by bringing them into the open and confronting them we may be able to deal with death, and life, in a more realistic and wholesome manner. Members of communities in which such experiences take place have developed rich resources for ministering to one another when confronted by death and grief. They can be open with one another to a far greater degree than exists in the usual “denial” of real feelings.
I am convinced that this entire process of opening up to each other makes it possible for persons suffering all kinds of diseases of body, mind, and spirit to live more fully and to limit to some degree the destructive elements that threaten us.
Ernest Rosenbaum: Unlike most of the people who support the patient and his family, the clergy continues to serve the family after the patient’s death by helping them through the process of grieving. The ritual of a funeral service and a post-funeral meal for family and friends is as much a supportive gesture toward the bereaved as an opportunity to say farewell to the deceased. Following these brief distractions, the survivors may experience a deeper state of shock than they did at the time of death. The period of mourning begins. There is no way to shorten or lessen the grieving process, although it can be shared and the pain, in part, alleviated through the compassion of others.
Many thanks to Tina Anderson for her assistance with this section. Reprinted from Living with Cancer, 1983.
Reverend Elmer Laursen
In 1960 the Reverend Elmer Laursen was hired by Lutheran Social Services of Northern California (LSS) to be the chaplain at UCSF. More The first Clinical Pastoral Education (CPE) program began in the summer of 1961 under Rev. Laursen’s supervision. CPE has continued year-round since that time to the present. In 1967, St John of God Catholic Parish was established by the Roman Catholic Archdiocese of San Francisco to serve the Catholic patients, students and staff of the UCSF Medical Center.
Reverend John D. Shanahan
Reverend John D. Shanahan was formerly Roman Catholic Chaplain, UCSF in San Francisco, CA. He earned an M.A. in Theology at University of San Francisco in 1969, and a Ph.D. at GTU/University of California at Berkeley in 1999. More During his first thirteen years of ministry, he served as Parochial Vicar at Saint Catherine of Siena Church in Burlingame, Saint Anne Church in San Francisco and Saint Robert Church in San Bruno. Father then ministered for three years as Chaplain of the University of California Hospital, and Moderator of the Newman Club of the University of California Medical Center. In 1966 Father John was assigned as Parochial Vicar of Saint Edward Parish in San Francisco, where he ministered until he was appointed Pastor at Saint Mary Star of the Sea in Sausalito. He served at Star of the Sea for 12 years, followed by a brief assignment as Pastor at Saint Elizabeth Church in San Francisco. In 1984, Father Shanahan began his 22 years as Pastor at Saint Patrick Church in Larkspur.
Rabbi Joseph Asher
Joseph Asher (1921–1990) was an American rabbi born in Germany, known for his advocacy of reconciliation between the Jews and the Germans in the post-Holocaust era, and for his support for the Civil rights movement in the United States. He was senior rabbi at Congregation Emanu-El in San Francisco for 19 years. Read more about Rabbi Asher on Wikipedia.
Ernest H. Rosenbaum, M.D.
Clinical Professor of Medicine, University of California, San Francisco, Comprehensive Cancer Center; Adjunct Clinical Professor, Department of Medicine, Stanford University Medical Center; Director, Stanford Cancer Supportive Care Programs National/International, Stanford Complementary Medicine Clinic, Stanford University Medical Center, Stanford, California. More
Ernest H. Rosenbaum’s career has included a fellowship at the Blood Research Laboratory of Tufts University School of Medicine (New England Center Hospital) and MIT. He teaches at the University of California, San Francisco, Comprehensive Cancer Center, was the cofounder of the Northern California Academy of Clinical Oncology, and founded the Better Health Foundation and the Cancer Supportive Care Program at the Stanford Complementary Medicine Clinic, Stanford University Medical Center.
His passionate interest in clinical research and developing ways to improve patient care and communication with patients and colleagues has resulted in over fifty articles on cancer and hematology in various medical journals. He has also participated in many radio and television programs and frequently lectures to medical and public groups.
He has written numerous books, including Living with Cancer: A Home Care Training Program for Cancer Patients; Decisions for Life: You Can Live Ten Years Longer with Better Health; Cancer Supportive Care: A Comprehensive Guide for Cancer Patients and Their Families; Nutrition for the Cancer Patient; Everyone’s Guide to Cancer Therapy; and Everyone’s Guide to Cancer Survivorship. For Everyone’s Guide to Cancer Therapy, Ernest Rosenbaum, M.D., Malin Dollinger, M.D., and Greg Cable received and Honorable Mention in 1991 from the American Medical Writers Association for Excellence in Medical Publications. Ernest and Isadora Rosenbaum received the same award in 1982 for their book, A Comprehensive Guide for Cancer Patients and Their Families.