The end of life
Ruth Hanusa is a chaplain for Saint Mary’s Hospital hospice program. The program, which began nearly four decades ago, was one of the first in the nation to offer professional home health care in conjunction with medical insurance for terminally-ill patients. If a patient has been diagnosed with a disease that will likely end in death in three to six months, he or she has the opportunity to spend that time at home with family and friends while still receiving professional care.
Patients aren’t required to have a chaplain come to their home if they are on hospice. With that in mind, Hanusa, 55, is always very delicate in mentioning her title to a new patient. She begins her relationship with a patient by trying to establish trust, while working with the nurses to coach the family on how to keep the patient most comfortable.
“Everybody lives and dies in their own way,” Hanusa says, describing the pain-management care needed for a dying patient. “We work with a pain scale of zero through 10, zero being nothing and 10 is the worst imaginable, and we ask that person what’s an acceptable level of pain. For some it’s zero, and for others it’s four or five, since they would prefer a certain level of pain and be more clear than to become foggy with medication.”
The family or caregiver will often know these specifics, though making these decisions for a loved one is no easy matter.
“It’s like dealing with a sick child, you call your doctor, your mother, your friend, and then you take your best shot,” she says. “But the best tool that you have is that you love your child, and that’s true at the end of life, too.”
Hanusa uses the term “death coaching” to describe the process of helping a patient and caregiver deal with death’s uncertainties. She compares the process of dying to that of being born. “We don’t know what it’s like being born, since none of us remember, but I think it’s really scary. … Somebody [once] said, '[It’s] no wonder they come out crying.'”
Although she works with death on a daily basis, Hanusa says it’s impossible to know what the end will bring: “The dead, they don’t call, they don’t write, they don’t email. We’re just taking guesses here at what happens. … The Bible has certain pictures of what heaven is like, but it also says that the kingdom of God is within you.”
Hanusa offers three specific things to comfort patients when she is called to their bedsides. The first is that the patient is “absolutely and unconditionally loved by God and/or their family.” The second is that “everything is forgiven,” and finally, “God will not abandon them.”
Hanusa, who has been a Lutheran minister for more than 20 years, says most people believe they must balance their good works with their bad at the end of their life: “Only you have the full list.”
The grieving process for those who have lost loved ones can take from two to five years, and the range of emotions can be great.
Anger is important.
“You had better have a God that can deal with your anger,” she says.
The reverend says it’s also important in grief to remember the happy times with those we loved.
“It’s like lighting a candle at midnight to say to the darkness, ‘I beg to disagree.'”