Ministry to Shut-Ins and Hospital Patients
By V. Rev. Arthur Liolin
This guide is intended for laypeople who want their service in Christ's Church to include visitation with those confined to home, elderly housing facilities, or hospitals. (For a Biblical reflection on this, see Matthew 25:31-46.)
Lay involvement in this ministry is vitally important. While the pastor brings the holy mysteries and his pastoral skills to the bedside, the care and concern of the committed lay visitor offers its own authentic assurance of God's love and mercy. Arrival at the bedside by the lay visitor poignantly expresses and underscores a vital link between the "people of God," and one of their own who is experiencing pain, sickness, and separation from family and community.
A lay ministry of the type outlined here is not intended to be isolated from the parish's outreach to the infirm; rather, it should be seen as drawing upon the personal gifts of the laity, and as a complement to the vocation of the pastor, upon whose guidance such a program should depend.
Understanding the Patient's Situation
However pleasant the facility, every patient must still adjust to a foreign setting and experience the disjointed and often impersonal sights and sounds of the clinical environment. The new patient's life-style has changed abruptly, with routine upset, and familiar surroundings altered. Faces appear strange, attitudes condescending. Changing shifts of staff mean more adjustments and the antiseptic setting often deprives one of identity and, therefore, of security. Even well-trained nurses and aides seethe patient as part of their job, for to become overly and personally concerned raises problems for them as well. The patient often feels lost, out of control with life and dependent on others.
Experience has shown that the visiting layperson can enhance the patient's sense of self-worth and caring with this ministry, when it is properly exercised. You, the visitor, are a contact with the community where the patient is regarded as an equal, where he or she is valued in his own right. Coming on behalf of Christ and His Church, you bring hope: a reminder of healthier days, of an anticipated return to an integrated life. You bring faith: that with the prayers of fellow parishioners the burden of illness may be transformed into a deepened strength and understanding of the human condition shared by all of God's creatures. And by your coming, you express love.
Here are some suggestions for conducting visits:
What To Talk About
This may be divided into three
a) General Conversation; b) The illness and Problems; and c) Restorative Prayer.
GENERAL CONVERSATION. Initial meetings should be light, friendly, and unstudied. You may wish to discuss the person's family, events in the parish community, the weather, the hospital environment. But be careful not to make the visit a shallow one. A patient is all too aware that things are not normal; pretending that everything is "just fine" only detracts from the visit's healing purpose, and patients can usually see through pretense. At the start, don't be afraid to "test the waters" to determine the patient's willingness to accept your visit for what it is: a special mission and outreach of you and of your church. If you are new at visiting, give yourself time to feel comfortable doing it. Be yourself, to be sure, but also expect to be challenged and to develop your own God-given gifts with people.
THE ILLNESS AND PROBLEMS. Patients are surprisingly often willing to discuss their reasons for being confined. The lay visitor should expect, and even encourage, a patient to air complaints. Patients need a responsive ear to hear them out. Expect them to go into minute detail about their circumstances. They will, and do. They are often at the "cutting edge" of their existence and your attentive support may help them accept their situation and grow in Christ because of it. This type of discussion is usually the most uncomfortable for the layperson to share, but it is absolutely essential if the visit is to have meaning for both. Time and experience aids in managing this, though few laypeople -- or clergy -- have the stamina to incorporate the pain of others into their own self-understanding.
Sometimes well-meaning and devoted people have no pattern or mechanism when thus confronted: they hide in roles or pleasantries, they weep internally, they may withdraw and, for this purpose at least, they fail. But if a personal prayer life, guidance and training accompany any initial discomfort, then the visitor's own ministry is on the threshold of growth. As a visitor you can expect to be both exalted and drained: exalted because the personal reward can be mutually fulfilling, and drained because, if you care, you'll often so sympathize with the patient that his or her ills become your own concerns.
If you have come this far as a visitor, it may bolster your confidence to realize how many kinds of help your visits are offering. First, by listening you bring the community to the patient and restore a feeling of self-worth and value. Second, in talking to you as a "church friend", the patient begins to overcome the feeling of depression at being an object (probed, inspected, cleaned by others, defenseless) and somehow becomes a person again.
Then too, you may recognize needs that others would not. You may see that the patient needs to talk with the priest and receive the Holy Mysteries. You may be able to help dispel any fear of Communion that the person has (because it may be associated with the approach of death) so that the sacramental healing of God's grace can become effective. You may, in this same vein, be the one who sees the need to encourage more visits by the patient's family, or encourage them to fill special requests the patient has made. All of these services are valuable, and your visits can provide them.
RESTORATIVE PRAYER. The priest is trained and ordained to pray for the patient and to administer the sacraments of unction, confession, and communion, as well as to give pastoral counseling. But the lay visitor can pray with and for the patient as well. Doing so serves the very important function of recalling for the patient the feeling of being in church with other laity. It reflects the Orthodox belief that physical separation of the faithful is overcome by their spiritual unity. Praying with a patient can have tremendous restorative power.
As a visitor, you may use brochures which the priest gives you for such prayers, reading them alone or with the patient, and beginning and ending your prayer with the invocation of the Holy Trinity and the sign of the cross.
Resources: What To Bring
The pastor may provide the visitor with several kinds of Orthodox reading matter, many of which are also available through seminary bookstores. These are important in several ways. First, shut-ins often get bored; Orthodox pamphlets and brochures provide an opportunity to enrich the patient's understanding of the Orthodox faith, place the illness in a theological context and often transform the patient from a passive communicant into a future helper of others who become ill or confined.
In addition to strictly prayer-oriented brochures dealing with sickness and death, other material can be brought, such as a parish bulletin. The Orthodox Church newspaper, descriptive pamphlets on confession, announcements of future social and church events. These help to assuage boredom during hospital stays and become a visible evidence of the church's presence with the patient. The layperson may also wish to bring a memento: an icon button, or icon print, flowers, a perfume or a soap; something personal for a person! It is the thought that counts more than the item itself. Some patients may enjoy a tape cassette or a book, and every parish should provide for this as part of its outreach.
Concern for the shut-in does not end with the visit. The layperson. having taken on this ministry, will often feel the need to pray for those visited and to ask the priest to pray for them during divine services. One parish has a listing of those in hospitals posted for all to see, although some prefer not to have their infirmity widely known and this is to be respected. In some instances a visitor may be expected to inform parish agencies of a parishioner's confinement so that a card may be sent and other parish groups can visit.
However, lay ministry to shut-ins is not to be confused with the group visits normally conducted by parish societies. This is why the visit should preferably by made by only one person, so that the individual nature of this work is kept intact. Group visits may, however, be beneficial in some instances, as in the case where a patient is unable to speak. Here the normal conversation of several makes for a less awkward experience. A group visit might also be useful in the case where a pastor is training a new layworker who needs initial encouragement in making visitations.
A phone call to patients after the visit to see how they are doing, whether they have other requests or desire another visit, is always a good idea.
Many layworkers keep a casebook to record their impressions both for themselves and in order to refine their approach. This casebook may be shared with the priest during regularly scheduled meetings With other laypeople visiting the sick, and provides an ongoing record of the development of the local parish program. The visitor's role can increase at this stage. Perhaps he feels that the priest should be asked to speak with the patient's physician, for example. Does the patient know the extent of his illness (and should he know?) Does the patient need Consultation regarding nursing home or rehabilitation stays? The layperson may serve as a facilitator, providing the suitable information and contacts to pastor or to family, while keeping the necessary emotional distance required to safeguard the program's real effectiveness.
Any layperson engaging in hospital ministry does so out of Christian charity and human compassion, love, and concern. Often, it is a rewarding experience, accompanied by the smiles and gratitude of the patient. But certain unpleasantness occurs which should also be anticipated. For one, the patient, once back to normal life, may avoid his or her former visitor! Why? The clergy and layperson have seen the patient precisely when he or she is most vulnerable. The layperson now knows the patient's weaknesses and this knowledge is often difficult for a past patient to bear. That same layperson who was so necessary, and comforting during illness now becomes a reminder of former insecurities. Any priest, social worker, or layperson involved in this type of ministry should expect this baffling yet understandable response.
Family of a patient usually are appreciative of church visitors; however, you are entering into a most private sphere, that of illness and family stress. People become highly sensitive and unpredictable during such crises. Be prepared not to be thanked as you might expect; or be prepared for suspicion and defensiveness following an initial expression of gratitude. This is the most disheartening part of this vocation; it is more unexpected and challenging than confronting illness with a terminal patient.
Remember that you are not God. Attachment to the people you are serving often brings with it a sense of power which is not your own. Serving as instruments of Christ, His Church and His mysteries, we often associate so closely with these same gifts that we blame ourselves when things do not go as we expect, or ascribe to ourselves the things which are of God. This also is a prevalent attitude among those in social services and human resources, and something to watch out for.
Do not be disheartened by these cautions but be humbled and purified in thinking about them. The layperson is not immune to these pitfalls and should rely on a personal prayer life, regular consultation with the pastor, and objectivity!
The vocation and tasks which you have undertaken are holy and blessed by God. Something in you has prompted this endeavor: care for people, service to God and His Church, a need to extend your faith with prayer and action (Orthodox 'praxis.') You will bring your own strengths, love, talents, concern, and faith with you to the hospital bed. But you will also bring your fears, prejudices, doubts, and failings. For you a1 so are a person in need of salvation and healing.
Strive to assist, but do not expect perfection. Indeed, your very fears and flaws can enable your ministry to be more effective and authentic. How can you help someone who feels lost, threatened, and dependent if you have not, in some way, felt this yourself? No; let your shortcomings turn into the very gifts which the patient you visit needs most: a sympathetic ear, a loving heart, a prayerful spirit and a friend from the Church who has come to be at bedside during a time of need.
Fr. Arthur Liolin is Chancellor of the Albanian Archdiocese and Dean of St. George Cathedral in Boston. A graduate of Princeton, he has studied Clinical Pastoral Psychology at Andover-Newton Theological School in Newton Centre, Mass.
of Holy Unction
An Orthodox Euchologian
Together by Your
Rev. Joseph M. Champlin
On Death and
on Pastoral Psychology
Henri J.M. Nouwen
Pastor and the Dying"
Rev. Joseph Allen (St. Vladimir's Quarterly)
A Grief Observed
C. S. Lewis
Death: The Final
Stage of Growth
For the Life
of the World
By a Monk of the Eastern Church
Taken from the OCA Resource Handbook for Lay Ministries