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Oftentimes caregivers, friends, and family are unsure of what to say and what to do to comfort the sick and the dying. Midwife for Souls provides specific Catholic insight and highlights the power of prayer as a guide. This best-selling book has been revised to include a new section of inspiring stories and lessons learned in hospice ministry.
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Midwife for Souls
Spiritual Care for the Dying
A pastoral guide for hospice care workers and all who live with the terminally ill
REVISED EDITION
by Kathy Kalina
Nihil Obstat: Reverend Timothy Shea, S.T.L.
Imprimatur: Seán Cardinal O’Malley, O.F.M. Cap.
Archbishop of Boston
October 23, 2006
Library of Congress Cataloging-in-Publication Data
Kalina, Kathy.
Midwife for souls: spiritual care for the dying / by Kathy Kalina.
— Rev. ed.
p. cm.
Originally published: St. Paul Books & Media, © 1993.
Includes bibliographical references.
ISBN-10 Print: 0-8198-4856-5
ISBN-10 eBook: 0-8198-4873-5
ISBN-13 eBook: 978-0-8198-4873-4
1. Caregivers—Religious life. 2. Hospice care—Religious aspects—Christianity. 3. Terminal care—Religious aspects—Christianity. I. Title.
BV4910.9.K35 2007
259’.4175—dc22
2006033299
The Scripture quotations contained herein are from the New Revised Standard Version Bible: Catholic Edition, copyright © 1989, 1993, Division of Christian Education of the National Council of the Churches of Christ in the United States of America. Used by permission. All rights reserved.
English translation of The Apostles’ Creed © 1988 English Language Liturgical Consultation (ELLC). 1988, and used by permission. See www.englishtexts.org.
Cover design by Rosana Usselmann
Cover photo by Mary Emmanual Alves, FSP
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system without permission in writing from the publisher.
“P” and PAULINE are registered trademarks of the Daughters of St. Paul.
Copyright © 1993, 2007, Kathy Kalina
Published by Pauline Books & Media, 50 Saint Paul’s Avenue, Boston, MA 02130-3491. www.pauline.org.
Pauline Books & Media is the publishing house of the Daughters of St. Paul, an international congregation of women religious serving the Church with the communications media.
For Mary,
the ultimate Jewish mother.
Let us love
with the urgency of the dying
and the innocence of the newborn.
Let us love
with the abandon of adolescence
and the certainty of adulthood.
Let us love
generously and openly
taking all risks—
for as we have been loved,
we must love in return.
And in the love that redeems us,
we open our hands and hearts
gathering a bouquet
to offer to heaven.
Katherine Mary Krsak
Contents
Foreword
Preface
Acknowledgments
1. Hospice Care
The Dignity of the Dying
The Death Event in a Fragmented Society
Midwifery for Souls: Birthing to Eternal Life
2. Family: The Basic Unit of Care
Wounds and Battle Scars
A Privileged Guest on the Journey
You Are Not in Charge
You Can’t Fix Sick Families
…But God Can
3. The Work of Dying
The Urgency to Love
Life Review
Reconciliation
Am I Going to Die?
Spiritual Distress
4. Signs of Active Labor
Dying Is a Physical Process
Dying Is a Spiritual Process
“An Angel from Heaven Appeared…”
A Time for Detachment
5. Praying Them over the Wall
Soul-to-Soul Time
A Time of Ultimate Choice
Complications in the Dying Process
Depending on Miracles
Near “Bad Death” Experiences
The Request for Death
6. Timing
Death of the Young
Sudden Death Experience
“A Time to Die”
Calling in the Family
The Final Farewells
Ministering to the Bereaved
7. Pastoral Care
Working with the Family Minister
Praying for Those Who Don’t Pray
Prayer with Families and Patients
8. Spiritual Exercises for the Midwife
Become a Pray-er
Live in a State of Grace
Live a Life of Forgiveness
Live a Life of Joy
9. The Problem of Suffering
The Cause and the Cure
The Question of “Assisted Death”
The Presence of Christ
10. Harvested Fruit
Allow Yourself to Receive
Allow Patients to Float Their Own Boat
Bow Your Head to the Mystery of Suffering
Practice Unconditional Love
Learn How to Pray Out Loud
Speak When Inspired
Take Care of the Story
Listen Well
Be Able to Beg Forgiveness
Suspend Judgment
Get Bossy Sometimes
Honor the Patient’s Journey
Don’t Ever Think It’s Easy
Appendices
1. Prayers
Prayer for the Dying
Prayer at the Time of Death
Prayer for the Family
Midwife’s Prayers
Chaplet of Divine Mercy
The Rosary
2. Scriptural Comfort for the Dying and Their Families
Suffering
Hope
Fear
Forgiveness
Heaven
Notes
Foreword
MIDWIFE FOR SOULS IS A BOOK on hospice care, but it is much more than that. It is a “how to” for family members, friends, and hospice professionals involved in caring for terminally ill patients as they enter into the phase of their last moments, when life slowly ebbs away and death releases the soul to go home to God. These last days or hours are very difficult for family members, who often watch helplessly by the loved one’s bed, not knowing what to do or say.
The author is a nurse, but she is also a deeply spiritual person writing from her personal experience. Kathy Kalina makes no apologies for being “one hundred percent Catholic,” but her deep understanding of what human beings go through as their lives come to an end makes the book useful to everyone regardless of religious preference. It is written in a style that is both poetic and beautiful as well as practical and credible. It talks about how powerful prayer can be; it talks about how important it is for hospice caregivers to be attuned to this God if they are to be effective “midwives for souls.”
I highly recommend this book for all who care for the dying whether as professionals, friends, or family members. The many stories of peace and joy coming into people’s lives, even in the last few moments before death, point to why euthanasia must never be an alternative for anyone. Hospice care relieves pain and suffering—physical, psychological, social, and spiritual—so that patients can face the end of their lives in peace and with dignity. Just as midwives help mothers deliver a child, so hospice caregivers help the soul as it is “born into eternal life.” It is a sacred mission; it is a true vocation. I rejoice that a book on the “Spiritual Care of the Dying” has finally been written.
Josefina B. Magno, M.D.
President, International Hospice Institute
Preface
I HAVE COME TO BELIEVE THAT there are no accidents. My dear friend Dodie urged me to become a hospice nurse, and I assisted at her death in that capacity six months later. I’ll never forget sitting beside her bed as she told me that she had no intention of dying, thank you very much. Inspired by the grace that abounds at such times, I told her, “I am here as the midwife of your soul.”
I don’t think I’ve ever prayed harder in my life, and I don’t think I’ve ever felt such spiritual strength. Twelve hours later, with an expression that radiated wonder and peace, Dodie was born to eternal life. What could have been an unbearable loss became a joyous homecoming, and Dodie’s parents were able to say that their thirty-four-year-old daughter had a beautiful death.
I went to Dodie’s house with “head knowledge,” but I left with “heart knowledge.” Dodie’s death transformed me into an apprentice midwife. I am still an apprentice. Patients and families are my teachers, and I will not graduate from this school until my own death. So I will share what I know as one apprentice to another.
Even though I’m writing this book primarily for nurses, especially when beginning this work, I hope that those who want to serve as midwife for loved ones will also find it helpful.
Acknowledgments
Special Thanks
To the countless hospice workers who shared their stories with me;
To the patients and families who allowed me to be a part of their stories;
And to my parents, for showing me what a family can be.
One
Hospice Care
The Dignity of the Dying
I FELT CALLED TO HOSPICE WORK quite some time before I stopped whispering, “Wrong number!” Because of my hospital nursing experience, the thought of death conjured images of a slow, agonizing process, involving a helpless patient and a hopeless staff. It involved inflicting pain on already pain-racked bodies. I’m still haunted by memories of tying patients down to keep them from pulling out tubes, repeatedly sticking IVs into worn-out arms, and assisting with heroic resuscitative measures that we called the “million dollar send-off.”
When I provided this type of “care” for the dying, I had the same sick feeling as when I participated in the hospital “care” of women in childbirth. Even though I knew the academic and legal rationales for distasteful practices, it never felt right.
Many times families would tell me, “We want everything done for our mother.” I would shake my head, thinking, “They just don’t know what everything is.” Doctors have a tendency to think of death as a personal enemy, and that’s usually good. If I have an illness that can be cured, I want my doctor to wage all-out war against it. But once it becomes evident that treatment is not going to be successful, I want to spend my last days in comfort and peace.
I can understand why it’s hard for doctors to turn about-face at this point, but it hurts my heart to see patients put through the rigors of treatment, even such drastic measures as artificial ventilation, because the doctors hate to fail. My friend Dodie, for instance, was encouraged to start another round of chemotherapy three days before she died.
Fortunately, more and more doctors are referring their patients to hospice care when a cure is unattainable. And more and more families are asking for, even demanding, hospice care when that point is reached.
Hospitals are wonderful, necessary resources for the treatment of disease. But they are not the best places to die. Even if there are no painful treatments, the routine alone robs patients of control and peace. The focus is not directed to the comfort of the patient; it’s directed to the convenience of the staff and the overall efficiency of the operation.
Vital signs are taken every four hours, baths are given every morning, meals are served at predetermined times—and the patient has no control over this routine. Staff members come in the room throughout the day and night, carrying out a variety of tasks at their convenience. There is often some limit on visitors. And patients usually hurt, because doctors and nurses have been taught that pain cannot be eradicated, just made a little easier to bear.
In contrast, hospice care is focused on the control of symptoms instead of the cure of disease. Pain is unacceptable, not a necessary evil. And pain medicine is given in pain-free ways.
The patient is consulted and included when decisions are made regarding a care plan, and the family helps provide that care. Our tools are primarily our hearts and hands, instead of high-tech equipment. Death is neither hastened nor prolonged.
Hospice care is loving support for patients who are living their last days and for their families. This support is physical, psychological, and spiritual. The hospice team consists of nurses, doctors, social workers, home health aides, clergy, and volunteers, and their roles often overlap.
The first hospice in the United States began in 1974, but true hospice care is not new to this country. Care for the dying has traditionally been a function of the family, with generous community support. Nursing duties were the woman’s responsibility, and this art was passed down from mother to daughter. Hospitals were places for the homeless and the poor. It wasn’t until the 1930s and 1940s that medical advances made hospitalization an attractive alternative to home care for all illnesses.1
In the days when medical care was geographically inaccessible, however crude it might have been, families surely felt the helplessness of being unable to provide treatment for the dying. Today we have sophisticated and accessible treatment, but once those options have been exhausted, families are made to feel helpless in providing even basic comfort measures. Hospitals push families aside and, at best, treat them as guests. We are led to believe that death is a medical event best attended by experts.
The Death Event in a Fragmented Society