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A Case Study on Clinical Pastoral Education

CLINICAL PASTORAL EDUCATION A CASE STUDY OF “AMBER BILL” A PATIENT AT ST. PAUL’S HOSPITAL IN SASKATOON BY PATRICK AMPANI CASE STUDY ROAD MAP A. INTRODUCTION AND THEOLOGY OF MINISTRY B. PATIENT’S BACKGROUND INFORMATION C. FIRST ENCOUNTER (VERBATIM) D. PRELIMINARY REFLECTION a. my initial reaction b. main issues c. my plan of action d. psychological theory at work e. spiritual assessment f. theological reflection E. SECOND ENCOUNTER (followed by preliminary reflection including session a-f) F. THIRD ENCOUNTER (followed by preliminary reflection including session a-f) G. CONCLUSION A. INTRODUCTION AND THEOLOGY OF MINISTRY:

St. Paul’s Hospital is an acute health care facility offering a comprehensive range of services to residents of Saskatoon and its environs. Inspired by the example of the Grey Nuns, who, in their shared faith in God, revealed the goodness and love of God, the creator of all people by way of honoring the mystery of life, respecting the dignity, worth, and uniqueness of all people, the hospital continues to provide health care with understanding and compassion, valuing the spiritual, emotional, and physical well-being of patients and families, and responding creatively to the urgent needs of the community.

In Collaboration with the health care institution, I exercise my duties as a chaplain, observing the norms and values adhered in the hospital. Operating in the context of my ministry as a spiritual care-giver, I see myself as a servant care giver who listens to and supports the sick, the elderly, the disabled, and their families. The act of care giving is ‘time giving’. We are created in time to live in mutual dependence with a sense of solidarity to one another. Since we all share the same human frailty we all need the support and encouragement of one another.

My role therefore is to make myself available with passion as a companion to listen and support, not because I have the answers to the anguish or questions, but my presence offers the patients the opportunity to outpour their anguish and concerns, thereby gaining some spiritual and emotional relief in their individual and collective pilgrimage in the world. B. PATIENT’S BACKGROUND INFORMATION: The patient in question for this case study is named Amber. She was 81 years old and was diagnosed with terminal cancer. The cancer disease had taken the better part of her internal organs that she only had a few days to live.

This sad news was a hard pill to swallow for the patient and her family. There was the usual initial denial, and they had been struggling for weeks to accept the bitter reality, hence that seemed elusive to them. There were desperations and anxieties in this very difficult and helpless situation. However, both the patient and the family were open to any support system from all fields of life. Amber, at the time of my visit, was lying on her sick bed with her two daughters, each sitting on either side of her bed. She was being dripped and a wet towel was placed on her forehead.

There were some get-well cards from both family and friends, pinned on the wall along side the family pictures with some decorative flowers, pasted strategically, so that Amber could see. She had a beautiful rosary on her neck and a crucifix in her hands, the one given her at the funeral of her husband. She held it so close to her heart as she looked at the family pictures intently. Both Amber and her children were looking at each other in absolute silence. The 81 year old lady originally came from Ontario. Her parents migrated from Poland to Canada shortly after their marriage and made Canada a home.

Amber had four siblings who preceded her. She was brought up as a Roman Catholic and got married to a Roman Catholic, thereby raised their family in the Catholic faith in Ontario. In their marriage, God blessed them with three children: a boy, Jim, and two girls Kate and Anne. Both Kate and Jim are married with two kids each, but Anne remains single. In the midst of this crisis, I met only Kate and Anne, a grandchild, and her son-in-law Tony. Jim was never there for the mother due to the long existing tensions between him and the family. This was a thing of concern for the patient in her dying bed.

The patient was anxious about the tensions in the family, on how to deal with it and resolve it, as well, she was anxious about dying. These anxieties enveloped the entire family, and everyone wonders what’s next now that the seeming unifying factor is dying. The dynamism of the family was critical and overwhelming. When I first met Amber, she was quite conversational and lively. In spite of her inherent predicament she was engaging. She could eat and drink on her own, watched TV and sometimes with the help of the staff and her kids she walked some distance and back to her bed.

But, as time went on, she declined from some of these activities due to body weakness. She could not eat or drink without being helped. She hardly sat up, or moved her legs or arms; her condition kept deteriorating gradually until everything finally shut down on December 24th, 2009. I met Amber in the course of my daily visitation routine as a chaplain in the hospital. A spiritual care-giver had left a note on my desk indicating that Amber Bill had specifically requested to see a priest. I immediately responded to that concern.

As I visited with Amber, I tracked the conversation and I came to realized that Amber has some emotional concerns as she faced her last days. Her care-givers, I mean her children, welcomed the idea of me spending time with their mom who seemed anxious about death and the thereafter. True to their words Amber explored her feelings, acknowledged and named her anxieties. This was so insightful and it encouraged me to render her support as much as I could. It was a life journey that would alleviate her pain and anxiety and bring her some comfort and serenity[1].

Here below, is my first verbatim account. In this verbatim account, we shall use the following codes: “S” for the spiritual care-giver, “P” for the patient, “A” for Anne and “K” for Kate, both her daughters. C. FIRST ENCOUNTER (VERBATIM ACCOUNT) S1-Hi Amber, how are you doing today? P1-I am not bad. I am taking one day at a time. It is a hard and difficult thing to deal with. It is difficult for me and my kids…sobbed in silence…. I am dying of cancer and I am afraid…(silence…when she had gotten some momentum she continue. ) Kate and Anne could you excuse us please!

A1- Ok mom, maybe we could just go and take coffee for 20 minutes and come back. K1-Mom, please speak out your worries and be free. You requested to see a priest; we thank God he is here. Maybe I’ll close the door, and Patrick speaks aloud because she finds it hard to hear sometimes. S2-Ok. I have come to visit with you, to be with you, to listen to you, and to support you. What has been happening with you? P2-I have so many things on me that I don’t even know where to start. Two months ago I was diagnosed with cancer (pointing to her stomach) that will cause my death.

I am afraid to die and I don’t know what is there after. I know I am a Christian and a Catholic, but I am just afraid. Maybe because there is an unresolved tension that exist between me and my son for about 15 years. This tension has escalated to my two daughters. I want to make peace before I die. S3-Amber, thank you for the confidence reposed on me. I may not have the solutions to these issues, but know that you are not alone, I will journey with you. So what is the doctor saying to you about the cancer?

P3- He told me that the cancer had spread all around my system and there is nothing much he can do other than controlling the pain. The sickness is terminal, and I am afraid of dying. S4-Death can be scary! So how do you deal with that reality? P4-(Silence) …I know God is with me. I am not really afraid of dying because I must die, but my fear is the thereafter. I know I will meet my husband, my parents and sibling but I don’t seem ready. S5- it is quite a journey! Every journey needs some preparations, so how do you do it? P5-(After a period of silence she spoke up) I need to make peace with God.

I will prepare my mind and make confession. I will make peace with my family, but I don’t know how because my son does not pick up my calls. He had not been talking to me for about twelve years, I think, shortly after the father died. It will give me peace if I can see some of my good friends to talk and to bid farewell and maybe they can pray for me. S6-Interesting! P6- I wish that when I die a funeral service is said in a funeral home with some friends and my family, after which, my children would take my body to Ontario to bury me beside my husband.

S7- So your children are aware of this? P7-Yes they are. I’ve told them and made provision for that. (The children came back to the room, and I ended the visit since it was confidential. ) S8- we shall now pray for you, together with your children, and I will go and come back tomorrow to see you. How is that for you? P8- That will be nice to talk to you again. S9-what would you like us to pray for. P9- Pray to God to take away my fear. S10- Let us Pray: dear God, we bless your holy name for the gift of your daughter our mother and grandmother Amber who is sick.

She believes and trusts in your providence and you know her anguish. Please God alleviate her from pain and unnecessary anxieties and grant her peace and the serenity she desires. We ask all this in the name of Jesus the Lord. Amen. P10- Thank you very much, I felt some relief now (stretching her hand for a farewell shake, while the daughters appreciate my presence. Anne came out of the room to talk to me. ) A2- I know mom would have told you a lot of things about the family. Since you will be coming back tomorrow, to see mom, I have a request to make. S11- what is it about?

A3- Please ask her for me if she will be okay with me going back to Ontario to continue with my job because I am not strong enough to witness her dying. I have spoken to Kate and she told me that it’s understood. S12- I will talk to your mom tomorrow and I will create time to talk with you about that. A4-That will be nice. Thanks so much for being there for us. PRELIMINARY REFLECTION This preliminary reflection consists of six parts; my initial reaction, identifying the main issues, my action plan, identifying the psychological theory at work, spiritual assessment and gives a theological reflection. . my initial reaction My initial reaction, questions and feelings based on sadness. Why could this woman who looks lively and strong de just like that? I thought of confirming this sad news from the nurse in charge if her case is hopeless as its being said. The assertion of her terminal cancer confirms the aggressiveness of cancer disease which has caused the death of both young/old, strong/weak, and rich and poor alike. Why have the causal effects of this deadly disease and its remedy remained a mystery to humanity? I feel ad that families and friends watch helplessly their family members gradually fading away in the cruel dent of cancer. In my sadness, I empathized with Amber and her family who amidst this predicament suffer loss of family connection and friendship. b. main issue The main issue is the life threatened cancer that is being surrounded with fear and anxiety about death and the life after and the existing tension in the family. These phenomenons are destructive in their very nature and above all they could steal or rob people of their gleaming hopes.

These negative emotions have enveloped Amber and her family and I knew that they needed support. Their goal amidst the inevitable was to make peace with God and with one another upon which their anxieties would be put in control. In other to achieve the intended goal, I focused my conversation around their emotions. c. my action plan Realizing that Amber was anxious about her predicament and very insecure of her family dynamics, I dimmed it necessary to make out time to support her as well as given attention to her children too.

There were clear indications from the tone of her voice to her body language expressing how uncomfortable she was to sharing about her predicament before her children. My plan was to make out more time with her and her family as to connect with them at separate times and to be a person they could trust enough as to articulate their feelings and concerns. d. psychological theory at work The psychological theory at work on this visit is the family system theory which was introduced in the 1950’s by Dr. Murray Bowen.

The theory suggests that individuals cannot be understood in isolation from one another, but rather as a part of their family, as the family is an emotional unit. The family as an emotional unit is composed of relatively autonomous individual. Although, relatively autonomous, they are knitted together that they function in reciprocal relationship as a result of which they mutually influence one another. Each member is motivated by his/her own particular psychological mechanism, but the individual behavioral attitudes are understood within the context of the functioning body (the family).

There is an intense affinity or a sentimental attachment, a kind of connecting force or gravity that exists among families which define their mannerism. An example of the major way in which this reciprocal process is played is when a family member is sick or anxious; the other members become more of care-givers. Talking of anxiety and togetherness force p121, Bowen observed that “when people become more anxious, the togetherness pressure increases …as anxiety increases people experience a greater need for emotional contact and closeness…” If the family was a functioning system, i. e. ithout tension and anxiety that could have alleviated Amber’s pain, fear and anxiety, perhaps she could die peacefully knowing that she was cared for and that the family is peacefully together. e. spiritual assessment Spiritual assessment tool provides a frame work of questions to help me in listening and in my observation around the patient in other to have the valuable information to dealing with the patient’s spiritual needs. I apply faith based questions as a scope for holistic care giving. Amber‘s inability to reconnect with her son and to restore the family peace was a thing of concern to her.

What is the life circumstance and relationship important to her? What could she believe in that gives meaning to her life? What could be the meaning of hospitalization since her days are numbered? What could be the source of her hope and strength amidst this event? Could she see meaning in all these? Could this be God’s holy will; a punishment; a part of life; or the beginning of the end of the journey? How is God understood by Amber: A source of strength, hope, comfort, or a harsh judge and a distant father? What could bring hope and support to her: Prayer, religious belief, family or friends?

How would I express the hope and support: Through prayer, reading the Bible, sacraments, religious service or the use of sacramental? Articles of faith like the Rosary, the Bible and the crucifix were very significant to her. Patients and families often feel better simply because they are been given the opportunity to share their faith. During my initial visit, Amber made known to me that her family is catholic and in exercising her faith she had met a deal of friends who are part of her support system. She willed to have her family and friends come to pray with her.

Family and community was a central part of her spiritual and social experience. However, patients and families sometimes have fears related to spiritual issues that they may be hesitant to express. The presence of a clergy or a spiritual care giver can significantly relieve distress. My visit with Amber brought some emotional and spiritual relieves. F. theological reflection Belief in some kind of life after death is a widespread feature of human cultures. Amber expressed her anxiety over death and the life after. The expression of her anxiety provided me with my theological reflection passage.

In John’s gospel 14:1-3, Jesus tells his disciples: “Do not let your hearts be troubled. Believe in God, believe also in me. In my father’s house there are many dwelling places. If it were not so, would I have told you that I go to prepare a place for you? And if I go and prepare a place for you, I will come again and will take you to myself, so that where I am, there you may be also. ” Amber was deeply anxious and afraid that God had abandoned and forgotten her. But God through Prophet Isaiah addresses her anxiety assuring her that even if a mother forgot her baby at her breast, God would not forget his own (Is 49:14-15).

On the other hand, Jesus reminds us that we are Gods precious children. He tells us not to be anxious about life because our fear is not the ultimate reality, but God. Anxiety robs us of the present or prevents us from living life to the fullest. He urges us to entrust our past to God’s mercy, our present to God’s love and our future to God’s providence. Amber’s anxiety was a share human fragile nature, but above all God is the ultimate reality whose grace and mercy surpasses any human comprehension. D. SECOND ENCOUNTER (followed by preliminary reflection including session a-f)

On the next Day, while her children were away, Amber and I had a 45 minute visit building on the relationship founded on the previous day. Amber opened up to me with no hesitation and we had what I would call “a healing discussion”: a discussion at which she expressed her emotions and anxieties so much that she felt like a heavy burden was lifted off of her. Here is the account of the visit. S1- Hi Amber how are you today? P1- Hi am better, I am glad you kept your words. A1-Mom had just asked of you a few moments ago (her daughter chipped in). Welcome and thank you for being here for us.

S2- it’s my pleasure! P2-Anne, you will have to excuse us again. A2-Okay Mom, I will use this time to go to the bank and get some money, and I will tell Kate to hold on since Patrick is here with you. (Kate had gone home to take a nap while Anne keeps vigil with Mom. ) S3-you look bright today, what’s the secret? P3-my journey is real and I am getting prepared. Could you listen to my confession before we go into some other discussions? S4- Sure! (I got my stole around my neck, prayed in silence and listened to her confession, and gave her absolution. P4-This makes me feel better again. Thanks for your comforting words. S5-you are welcome! So how has your day been? P5-Things have been about the same. Now that I made confession I feel a lot better. S6-So you are not afraid of dying? P6-The fear comes and goes from time to time. I don’t know what to do. Maybe I think of death as an entity that will come and knock at the door and say “I’ve come. ” (Laughs) I hope it comes while I am asleep. I want to die in my sleep. S7- So other than dying itself, which you may not know when to go what other fear is in you?

P7-I was afraid that God would abandon me, since for about 10 years now I’ve not been going to church on regular bases. But I trust in God’s mercies that he will forgive me and accept my prayers. S8-God’s mercies have no limit. Do you see him around all that is going on with you? P8-Yes! I know he is with me and he has brought you to me and he is using the doctors on me to relieve my pain. I know he loves me. S9-As you experience God in your life, how do you experience him in your children? P9-My kids are difficult, especially my son.

He has not been talking to me for over 10 years. S10- Woah! P10- He says “I love my girls more than I love him”; but for me I didn’t do anything wrong. I never gave my girls anything and refused him, I love them all, but he would not talk to me or visit me. He has two kids but they don’t know me as a grand mother. I feel sad about all these. S11- waoh! So what do you intend to do now that you are facing this reality? P11- I had been praying this rosary (showing me the rosary) for them. I wish I could talk with him before I die. Meanwhile they had talked about this with the social worker who promised to do something the next day) When Kate returned I will ask her to call him again and plead with him to talk to me. S12 -So you want to reconcile and make peace with him before you die? P12- Yes! But I have done no wrong I can’t apologize. S13- so what do you do? P13- I would tell him I love him and bid him farewell and bless him with his family and tell him I don’t have anything against him. I will bless my daughters and friends, they have been wonderful; without them I don’t know what I would do.

I love them all. I wish I can have my good friends come to see me. S14- Amber, the journey of your life is an interesting one. How do you figure out how to do all these? P14- what else can I do other than to rely on God? The doctors and the staff have been excellent; once I am not in pain I think a lot. Ouch! I am in pain please call the nurse for me. (the nurse immediately came in and gave her some dose of pain killer, while I remain quite seated. When the pain subsided we continued with the visit). Sorry about that! S15-No no no! You don’t have to be sorry. I hope you feel better now. Kate came in and after a short while Anne came back as well. At that point the mother became sleepy and we allowed her to take her rest. ) K1- Patrick, Can I talk to you please! S11-Sure! K12- My mom worries a lot because of what is happening in the family. She and my brother are not in talking terms, he only talks with me but does not talk to Anne too. The social worker promised to do something about it tomorrow. We hope it works. Anne and I are not in good terms too and mom knows that. Every Jewelry of mom Anne claims it has been willed to her, I don’t accept that.

Maybe because she stayed with mom since she had no house of hers, mom does everything, and now she wants to have everything when mom dies. I will not accept that. S12- So how do you deal with this now that your mom is dying? K3- Yesterday, we quarreled and insulted each other in the room, mom wept. I will apologize to mom and to Anne. I still love my sister and I will love her again because she is my only sister. Sorry for taking much of your time. S13- Thanks for confiding in me, I am glad you will make peace with her. PRELIMINARY REFLECTION

This preliminary reflection consists of six parts; my initial reaction, identifying the main issues, my action plan, identifying the psychological theory at work, spiritual assessment and gives a theological reflection. a. my initial reaction: I felt relieved and consoled as I listen to the tremendous shift Amber has made from being anxious to accepting the reality of her journey and her resolution to reconciling and making peace with God and the church. Amber had accepted her life threatened condition and was comfortable talking about it.

Listening to Amber I was a shift from shaky faith to solid faith in the God of mercy who loves her even in her dying situation. Again, I was overwhelmed with empathy as I listened to Amber expressed her sadness over the dysfunctional attitudes of her only son, which had caused more anxiety to the family. But I was consoled of her motherly love for her children when she said: “I would tell him I love him and bid him farewell and bless him with his family and tell him I don’t have anything against him. ” This positive spirit radiated in her daughters who were not in talking terms with each other but resolved to make peace.

There willingness to make peace with each other made my job easier. b. main issue: I saw three main issues; first Amber and her son are not in talking terms. The son who is married with two children has chosen to remain distant from the family because it was too hard on him to endure seeing his mother loved his sisters more than she loves him. Amber hopes in God’s providence to enable her reconnect with her son and to restore the peace of the family. The second issue was her wish to have all her closed friends come by to pray with her and to bid farewell.

The third issue is around Kate and Anne over Amber’s jewelry as to who will inherit them when she dies. This huge appetite for the inheritance aroused a question in me as to what is more valuable to Kate and Anne between their mother’s comfort and peace and the jewelries. c. my action plan: In her desperation to talk with her son, Amber had planned to ask Kate to call him and plead with him to accept her phone call and talk with her. Meanwhile, they had employed the services of a social worker ho offered to come the next day as to help them through the issue. I hose not to interfere with all those plans; instead I opted to collaborate with the Social worker and the medical staff to work as a team. I believe that it is in collaboration that we can identify the best way to care for Amber and her family as she prepares to die. In view of this we were able to talk with her son who got open to talk with his mother and we invited her closed friends for a visit and a prayer session. d. the psychological theory at work: The psychological theory at work is the family system theory which has eight interlocking concepts developed by Murray Bowen.

These concepts help us to understand the responses and the mechanism that exist within the family system. The family postulates the existence of life forces that govern relationships from the individual to the relational body system. This emotional system reflects the interplay between the counter balancing life forces individuality and togetherness. The family system theory addresses the human capacity of cohesiveness and cooperation. The higher the level of differentiation in a family, the more they can cooperate, look out for one another’s welfare and stay in adequate contact during stressful as well as calm periods.

But the lower the level of differentiation the more likely the family gets stressed out and regress thereby emotional cutoff of member. The son’s decision to distant himself from the family made me wonder about his level of differentiation. Perhaps the amount of emotional energy to be burn in the relationship was too great a deal for him as a result he chose to remain distant to protect himself from pain or he opted not to get enmeshed with the emotional needs of the family.

Unfortunately his decision to distant himself from his nuclear family will not relieve his anxiety, nor will it help bring emotional balance to the rest of the family. However, my role as a professional spiritual care was not to fix their emotional problems but to encourage every family member to be open to have honest communication with other members in spite of their uniqueness so as to strengthen the family’s bonds during this time of crises. e. spiritual assessment: Amber’s strength and hope comes from her personal faith in God who has been accessible through personal prayers, reading of he Bible and through the instrumentality of the medical staff, spiritual care and social worker staff, friends and families to control her pain and anxiety and to regenerate hope in her even as she is dying. This episode reminds me of the abounding grace and mercy of God unto his own people. f. theological reflection: It is shocking to discover that the system we built to support us proves too fragile to bear the weight of our hopes. Sooner or later we realize that we live in a complex world, and the more complicated the world become, the more insecure and anxious we feel about life.

In John’s gospel 6:24-34 Jesus tells us not to worry about life, body, clothing etc for we cannot add or subtract one single cubit to our span of life. Anxiety robs us of the present and prevents us from living life to the fullest. But our anxiety is not the ultimate reality but God. This tells me that God is infinitely present in our world dwelling with us no matter our individual life situation. E. THIRD ENCOUNTER (followed by preliminary reflection including session a-f) On my final visit I met Amber sleeping and I knew that the day was fast drawing nearer.

Kate said “mom has all been sleeping through out today. I sought to know from the children whether they know all her good friends here in Saskatoon. One of Ambers wishes was to have them come. Her children agreed to contact them and invite them to come at 4pm the next day if it works. S1- Anne you wanted us to talk is it ok with you now? A1-Yes! (We moved out of the room to a quiet room to listen to her. As she begins tears filled her eyes. ) I am not strong enough to watch my mom dies, please talk to here if it’s ok with her so that I can go back to Ontario. I am afraid I will pass out if I see her die.

Please talk to her. I’ve talked to Kate and she agreed to stay back and watch mom while I go. S2-so Kate has agreed for you to go home, what is your mom saying? A2- I am afraid to tell that to mom she may think I don’t love her. I know she loves me and I love her too, but I don’t want to watch her die. S3-Do you not think she will be open to discuss that with you? A3-Ok, O will give it a trial. Anyway, thank you so much for your time. You are God sent to us. PRELIMINARY REFLECTION; a. My initial reaction:I was sad and I empathized with the family seeing that their mother has grown weak.

I equally empathized with Anne who expressed her anxiety to watching her mother die. I thought of paying close attention to facilitate some of Amber’s wishes and her family for it’s the key to a peaceful death. b. Main issue: I recognized the fact that the cancer is getting to be too burdensome for Amber and she has grown so weak that all she does best was to sleep. The medical staffs have kept her pain in check while the clock keeps ticking waiting when death strikes. Another issue is Anne’s anxiety to witnessing her mother die; she would love to go to Ontario only to be told than to tell the story herself.

She solicited with me to talk to her Mother to understand her plight and let her go while her sister stay back. I chose to address with this issue immediately because it was the most pressing issue at hand. c. my plan of action: Anne wanted me to talk and convince their mother to let her go as to escape watching her die, but I knew that the best thing to do was to recoiled it back to her to take it up with the mother as to see what her response might be. Equally I requested Anne and Kate to contact their mother’s friends and invite them over for a prayer and a farewell ceremony with their mother. d. Psychological theory at work:

The psychological theory at work is the family system theory; every human being said Bowen enters the world totally dependent on others for his/her well being. In other words, every human being is a member and a product of his /her family of which he/she is biologically, psychologically and emotionally fused. However during the developmental years, largely due to physical maturation, his capacity to be responsible for himself gradually increases. As the years pass by, the developing child has the task of becoming an individual in his own right and the parents have the task of functioning in ways that permits that individuality to emerge.

That enables him to grow to be an emotionally separate person, and individual with the ability to think, feel and act for him as well assume to, and remain emotionally connected with the family. The togetherness force propels a child and family to think, feel and act as one. The result of these counterbalancing life forces is that no one achieves complete emotional separation from his family. The early attachment is never fully resolved. Amber although emotionally connected with her family, shows a good level of differentiation.

Amber’s individuality is a biological and psychological rooted life force that propels her to follow her own directives to be an independent and distinct entity. This force is reflected in the feeling and action mood of Amber who propels an emotional balance in the family system. e. spiritual assessment: As I listened to Amber’s story, I realized the complexity of her situation, in a very short time, Amber gave me a lot of information about herself and her family and what is irking her. I empathized and felt so sorry for her that even when she still looked firm her days were numbered.

I realized I could do nothing about her cancer, but I was interested in discovering her source of strength on how she deals with all the issues surrounding her: her worries or anxieties over her ill health, the ongoing tension in the family and her fear of death and the thereafter. In the cause of the journey with Amber I discovered how strong faith she had in God, and that she hopes with God’s help she would make peace with her family and overcome her anxiety over death and thereafter. She demonstrated a high sense in God by praying the rosary and reading the Bible.

Her faith in God prompted her to have received the sacrament of the anointing of the sick trusting in God’s providential mercies. There were basically three things that mattered most in Amber’s life: her faith in God, her family, and her friends. She exhibited a high sense of faith in God by modeling her life in accordance to the norms of the gospel of Christ. She used three symbols of faith in my seeing: the rosary, which she wore on her neck, the cross, given her at the funeral of her husband, which she held to her chest, and, the Holy Bible which was a daily bread for meditation to her.

Her love and concern for her family cannot be over emphasized. We could see that, even at the point of death, she was concerned at seeing her family at peace with one another. Equally, her connection with her friends was so significant that she desired to have them come and spend a solemn moment with her at which they bade each other farewell. Amber’s crisis was enormous. She was faced with physical, spiritual, and emotional crisis. Her situation was complex.

Other than her anxieties surrounding her ill health, family and friends, amber was concerned about her funeral service and making sure her remains would be conveyed to Ontario to be buried beside her husband. Amber believed in the power of prayer, hence she prayed her rosary continuously in her dying bed and also requested the priest and her friends to pray for her. She had the conviction that there is power in the word of God, hence she read the Bible for her daily meditation. Amber above all held to the cross of Christ which she believed is the symbol of her salvation.

This gives me the insight that Amber was very religious. Amber’s personal strength and determination was evident. Being an open minded lady she made use of the available resources to alleviate her pain and anxieties. For instance she used the medical staff to know what was eating her up and what remedy could be available. She used both the spiritual care-givers and the social workers to address her emotional yearnings. This was awesome! To my mind, Amber had a strong sense of faith and total submission to the will of God that she never asked the question why God allowed that to happen to her.

Instead she glorified God whose hand she saw in her life and in her sickness. Family and friends were most important part of her life that she did everything within her reach to show how much she loved and cared for them. Her friends commented on her saying she was, outgoing, sociable, understanding, charitable and loving. Amber was dynamic and charismatic in her relatedness to her family and friends. Her affection for her family urged her to make peace with family members and taught them the importance of relationships.

To my mind, I could say the patient found guidance from God the source of wisdom and understanding, who inspired her through prayer and meditations to open up to the resources available in the health care system. Unlike some patients and families who would not welcome spiritual care service, Amber and her family, enjoyed the dividend of spiritual care services. I am glad they did! Every time I visit with a patient I try to track the conversation to know how the patient is coping with his/her situation and the possible sources of his /her strength.

Realizing the dynamic nature of the patient I therefore develop some strategies on how to track the conversation as to encourage the patient to explore his feeling, and emotions to alleviate the ongoing pain and anxieties. f. Theological reflection: Life is like a roll of tissue, the closer it gets to finish the faster it rolls. Amber’s beautiful life swiftly faded away. Towards the end of her life, she was faced with some critical issues but her courage and determination coupled with her faith in God saw her through and she died peacefully.

However until her death, she left as a legacy the principle of her life to her children and friends to learn: that the three most important things in life are; Faith in God, family and friends. These would ever be there for you and would never turn their back against you. In fulfilling her wish arrangements were made for her friends to come, the daughters gave me a call and requested me to be there. Five of her friends came, four ladies and one man. Each spoke with her saying they would love her forever, and they blessed each other. When that was done, I now requested them to joint their hand with Amber as we pray the Lord’s Prayer.

When that had been done, Amber in tears thanked them and said, “Thank you for being good friends I love you dearly and I am missing you all. Please pray for me as I die and be mothers to my kids. ” This reminds me of John’s gospel 19:26-27 where Jesus seeing his mother and the disciple whom he loved standing beside her, he said to his mother, “woman here is your son and to the disciple, here is your mother. ” Both Amber, her friends and her kids, wept as she talked I said to them it was ok to cry, your tears make sense. F. CONCLUSION On the next day being December 24, 2009, she had grown weak and barely talks.

Amber recognized me and I could read her lips thanking me for all the support I gave her and her family. The kids appreciated me and how fruitful my visits were to them. There mom was able to talk to her son again in her last three days. Anne and Kate made peace with each other in the presence of their mom, and finally her good friends came around for a farewell visit. What a blessing! I for one felt blessed to have encounter this very family. Coincidentally or by divine providence the funeral home invited me to celebrate her funeral service at Hill Crest funeral home. What a journey with the dying! ———————–

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