Anointings

Monday started badly. I had spent over 6 hours the previous week working with a patient and family coping with end-of-life issues. The focus of my attention was an elderly woman who knew she was dying but was clinging to the hope of some kind of clinical turnaround. Her daughter from out-of-state and her dependent son believed aggressive intravenous nutritional support was going to be the answer to her mother getting stronger. My best attempts to hear the patient's voice and help her were rejected with the ultimate “we don't appreciate you” response—both daughter and son wanted a different palliative medicine doctor. That was the first thing I heard in Monday's morning conference. On top of that, I was ill with some kind of upper respiratory viral bug. Several new consults were waiting, and I needed to complete rounds on the other patients we were following on our service. It was a tough day. By Wednesday I was still feeling the sting of rejection.

My morning was busy and it was with only 20 minutes to spare that I was reminded about a consult scheduled for 11:00 am. One of my colleagues, a critical care physician, had asked me to see a patient referred to him with amyotrophic lateral sclerosis that had been diagnosed 6 months earlier at a respected tertiary medical center. She and her family needed clarification of goals regarding gastrostomy feedings, tracheostomy, and assisted ventilation. I did some quick reading to familiarize myself with the prognosis and potential interventions associated with the disease. Our palliative care team coordinator and I then met the family near the admitting office of the hospital. The patient was in her early seventies, well dressed, sitting in her relatively new-looking motorized wheel chair with hand controls, and she greeted me warmly. Her four children accompanied her, all being cordial toward me and attentive to their mother.

Once we were comfortably seated in a private family room, the children began asking questions almost immediately. Although I make a point at family conferences to begin conversation with the patient, the children's focus on these questions prompted me to respond to them first as a way of letting them vent some of their anxieties. Their interest was focused on the technical nature of the procedures being contemplated and the timeframe in which they should be done. I answered a number of questions, and several times I saw the patient subtly shaking her head as I responded. The conversation gradually moved into issues of advanced disease and disability. I reminded the family members that the life-prolonging interventions would not change the progression of the disease, and eventually all of her personal hygiene needs would need to be dealt with by caregivers. At that point the patient, with words both desperate and dysarthic, cried out, “I don't want that! I don't want any of that!” There was silence in the room as she then began sobbing. After a few moments her eldest son approached her chair. She reached out and put her arms around his neck, telling him how much she loved him. I gently reassured her that she was the decision maker and we wanted to hear what was most important to her.

With the children now realizing the impact this discussion was having on their mother, they seemed more comfortable with my conversation directed toward her. She and her husband had lived for 50 years in the same small Midwestern town where they had raised their family. They still attended the same Catholic parish in which they were married. She had helped her husband on the farm they owned. He had not attended the family conference because of his dislike of talking about serious illness, an aversion he had demonstrated since she was first diagnosed. She affirmed that faith was important to her, but for some reason the current priest at their parish was seen by her and the family as someone not easily approachable. Seeing that she and her family were experiencing significant spiritual suffering, I asked her if she would like to have the hospital priest come pray with her and the family. The patient and family quickly accepted this offer. I was quite pleased with this decision because everyone in the hospital knew this priest as a warm, friendly, caring man. His full white beard made him look pretty convincing for Santa Claus. I had anticipated this would be a great encounter, and was disappointed to learn that he was out of the hospital for the day. Our team coordinator went out to see who might be able to come pray with the family, returning with another priest who just happened to be in the hospital seeing parishioners. He had graciously consented to come to the family room to pray with the family. The family knew him from previous church encounters and was obviously pleased to see him. He took his time moving about the room, warmly greeting each family member and finally stopping in front of the patient. I quickly summarized for the priest the circumstances that had brought her and her family to this point. He asked if she had received the Sacrament of the Sick, and when she said no, the children explained to him the situation with their parish priest. With considerable delight he announced that he carried the consecrated oils with him, and if she wanted to have the Sacrament of the Sick he could anoint her. He explained the general procedure, and then the professing Catholics in the room (though I'm not Catholic I felt comfortable to remain and observe) began their familiar and oft-recited liturgical responses to his promptings. The peace and reassurance that this observance was bringing to the patient and family were almost palpable.

As the priest began his recitation of the biblical text from the fifth chapter of James and applied the consecrated oil to the hands and forehead of the patient, I was reminded of a time many years ago when I was faced with my own crisis. Rather than impairment of speech, swallowing, and walking, depression had brought impairment of mental energy, motivation, sleep, and hope. I had asked my wife to call for the elders of my church to come pray with me and anoint me with oil—the rural Midwestern Protestant version is olive oil—and those who ministered to me brought the faith, hope, and love that were not available in medications alone. That evening meeting years ago was not the sudden miraculous turn-around of depression resolved, but it was the beginning of the journey back to wholeness. As I listened now to the words of the priest, my eyes filled with tears. I sensed the despair in the patient and family, but also the hope that the priest's words and prayers brought to all of us who shared this moment together. As the sacramental prayers and recitations concluded, the priest gave a brief word of encouragement to each family member. Finally, he touched the now smiling and appreciative patient lightly on the shoulder, looked her lovingly in the eye, and said, “Everything is going to be okay.” And I knew everything would be.