BY CLAUDIO CONSUEGRA

DIFFERENT REASON FOR MY VISIT might have made this drive through the Virginia countryside much more pleasant. But this was not a leisure trip. As the chaplain for one of the hospices in the Roanoke Valley, I was to visit every new patient to assess their spiritual needs and develop a ministry plan for them. This afternoon I was scheduled to meet Vicky,* our new patient, and Darren, her husband of more than 40 years.

Vicky's Last Days
As was my practice, I offered a quick prayer that God would use me to help Darren and Vicky during such a difficult, painful time. I then made my way to their door, taking in a few breaths of the crisp, fresh mountain air.

Darren opened the door and kindly invited me in. Vicky sat in her favorite recliner, looking out the window to their backyard. Her warm smile took away all the normal apprehension I usually felt at meeting a new patient. We talked for an hour about their lives, their family, their dreams. We talked about their understanding of her condition. Asking these questions helped me not only to ascertain their knowledge but also to determine at which stage in the dying process they might be.† Having felt I had gathered the information I needed, I asked my routine closing question: "Are there any questions I might be able to answer for you?" Darren answered quickly that he didn't have any questions. Vicky waited a few seconds; then she asked me a question I had never been asked before: "How will I know when I'm ready to die?"

In the few seconds it took me to recover from the surprise at her question, it was as if God gave me the answer. I responded, "The day you met Darren, if he had asked you to marry him, what would you have said?"

"I would have told him he was crazy."

"So then, I'm guessing you two met, went out a few times, talked a lot, dated for a while, and fell in love. Then one day Darren asked you to marry him, you accepted, and here we are, right?"

She smiled, looked at Darren, and answered softly, "Yes, something like that."

"Well," I said, "it's like that when it comes time to die. During the next few days, weeks, maybe months, you'll have an opportunity to get to know Jesus even better than you already do." I had learned that they belonged to a Christian denomination. "You'll talk to Him, you'll read about Him, He'll talk to you while you're awake and maybe even while you're sleeping. And then one day you'll hear Him say, 'Vicky, it's time to leave the pain of this world behind.' Then you'll know it's time to stop the fight and rest in Jesus."

Vicky sighed, looked up at me, smiled, and said, "I like that. I feel better."

During the next few months I visited Darren and Vicky regularly. Thanksgiving came and went, and Vicky was doing well. The Christmas season with all its joys and memories arrived and left, with Vicky surrounded by her children and their families. The next event was Easter, and it became more obvious with the passing of days that she might not make it that far.

The week before Easter I was at the office when Vicky's primary nurse came in quickly to pick up some medicine. She stopped by my desk and said, "I think you should go to visit Vicky; I was there this morning, and I think she's dying. I'm getting some stuff I need, and then I'm heading back there." I didn't even bother to call, but simply started out. When I arrived, Darren opened the door with a sigh of relief and said, "Oh, I'm glad you're here."

Vicky was semicomatose. I sat next to her bed, held her hand, and spoke softly. It is the commonly accepted belief in health care that hearing is the last sense to leave a patient, so one must be careful about what is said in their presence. I told her I was there and that it had been my joy and honor to have known her and Darren. I also told her that we would miss her--particularly her family. But I assured her that they would be OK, and she needn't worry about them. I then read to her the twenty-third psalm, giving special emphasis to the words "Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me" (Ps. 23:4, NIV). I then prayed and thanked Jesus for the life He had given her, for her family, for the many years she was married to her husband, and asked Him to take good care of them and to take care of her. As I closed my prayer with the customary "In Jesus name, Amen," she took one last breath, relaxed, and died.

Ministering to the Dying
What an awesome experience it is to help usher someone into their sleep of death, to help them during one of the most important transitions--indeed the last one--in their life! It's sad to think of the millions who die daily with no one's help or company. Here are some things you can do to help someone who is dying.

1. The ministry of presence. Most people feel uncomfortable, maybe even afraid, to talk about death and dying. Therefore, when they hear that a friend, loved one, coworker, or schoolmate has been diagnosed with a terminal illness, they stay away. In reality, what you say is not what matters to the terminally ill person or their family, but rather the fact that you cared enough to come be with them. However, respect their privacy and always call beforehand. If they are in a hospital, you must not only respect visiting hours but also be conscious of the fact that those visiting hours may be the only time the family gets to spend with their loved ones. Make your visits brief.

2. Listen. More important than what you say is how much you listen. While most people's greatest fear is not knowing what to say, if you go prepared to listen and let the terminally ill lead in the conversation, you might find that death is not all that's on their mind. They just want someone to talk to.

3. Empathize, don't proselytize. If the person who is dying does not share your beliefs, this is not the time to try to convert them to your belief system; to do so may cause more anxiety than assurance. For instance, several of my patients talked about going to heaven after their death. Rather than lecturing on the state of the dead, I would say something like "As Christians we have a special hope, don't we?" or "That's a comforting thought, isn't it?"

4. Offer practical help. Many people take the easy way out at the end of a visit with the standard offer "If there's anything I can do, just let me know." The reality is that during these difficult times the challenge for the patient includes thinking about what needs to be done or asking someone to do it. It would be better to offer to do specific things for them--mow the lawn, wash clothes, or run errands such as grocery shopping. Sometimes an offer to stay with the person who is ill to relieve the caregiver for a few hours can be the welcome help they need.

5. Watch for special events. People who are terminally ill seem to have control over when, where, and how they die. One of my patients waited until the day after his daughter's birthday, and the night he died he was so restless that his wife decided to sleep in the living room. When she woke up the next morning, he was dead. He had chosen not to die before or on his daughter's birthday, and he didn't want his wife to see him die. Others wait for loved ones' or their own birthdays, anniversaries, graduations, baptisms, weddings, and other special occasions. Be aware of this fact as it may help you get an idea of when they might die.

6. Fear of dying or of death. One of my patients told me he was afraid. I asked him if he was afraid of death or of dying. He said, "I'm not afraid of death; I just don't want to die in pain." Most people are afraid of the dying process, and not of death itself. In his case I assured him that we in hospice would do all in our power to keep him comfortable and without pain or discomfort. That assurance helped him relax and enjoy the last few days of his life. If the person you're visiting expresses such fears, clarify what the source of their fear is, and if they are uncomfortable or unable to answer, ask someone else who may be better able to answer.

7. Help them to die in peace. In hospice we have learned that those patients who struggle the most in their dying process seem to be the ones who have strained relationships with someone. It may help them to ask, "Is there someone you would like to see or talk to?" Offer to contact the person they'd like to speak with. If the other person is not willing to speak with the terminally ill patient, you can facilitate the expression of their feelings by offering options such as, "If you could talk to them, what would you tell them?" You may offer to help them write a letter that they can then choose to mail or burn, thus symbolizing their having taken the step of reconciliation. Many patients wait to die until after they see someone they care about, so you could offer to help make the contact.

Another way to help them die in peace is to pray for and with them. The medical field has come to recognize the benefits of praying for those who are ill. We need not feel the obligation to pray for healing; it does not reveal a lack of faith, but recognition of the inevitable. When I pray with and for members or patients who are terminally ill, I pray for comfort and peace, courage and strength, hope and renewal of love for themselves and for their loved ones.

Instruments of Peace
Dying can be a difficult and painful experience, or a special memory for their loved ones. You can be instrumental in making it as comfortable and comforting as possible by carefully doing for them what they need as they write the last chapter in their earthly life.

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*Not their real names
† Elisabeth Kübler-Ross describes the five stages that those who are dying go through as: denial, anger and isolation, bargaining, depression, and acceptance (On Death and Dying [New York: McMillan Publishing Co., 1969]).

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Claudio Consuegra, M.S., is a pastor, law enforcement chaplain, and police patch collector.