Sorry, that's probably a very gloomy lost title, it's based partly on the name of a book I will be mentioning, and partly on what I think pastoral care of dying or terminally ill peopple is about.
A lot of stuff recently has been reminding me of an essay I wrote - a very long time ago - based on my experiences of accompanying a couple through the final months of the husband's life. Diagnosed with metastatic liver cancer, his GP expected him to live maybe six weeks; in the end he lived for nine months, before slipping away. As a green trainee minister type person, I read lots of stuff to help me face the challenges of caring for this couple, and found some concepts and images that have remained with me since. It was useful today to spend a little time reading my essay and reminding myself what it actually said, not what I remember it saying!
The first image I used was from a book called Letting Go by I Ainsworth-Smith and P Speck, London SPCK, 1982 (a newer edition is now published). They defined what they called 'cones of awareness' around an individual person.
Cone 1, for the healthy person, is very wide, including work collegaues, relatives, immediate family, neighbours, friends, leisure companions and acquaintances, as well as (potentially) religious and medical professionals. The healthy person can relate quickly and easily to different groups and is energised by the diversity.
Cone 2, for the sick person, narrows somewhat; work colleagues, acquaintances, leisure companions may be excluded (or exclude themselves) either de facto or through choice. The sick person has less energy and is able to concentrate less well and for less time. Relationships can actually prove sapping rather than energising.
Cone 3, for the dying person, becomes increasingly narrow, until they are alone, metaphorically if not literally. Consciousness may be fleeting, conversation draining. In the end, death, like birth, is something experienced alone.
Depending on the nature of the illness or condition, the sick person may revert to cone 1 as they recover. This is the experience, to some extent, of anyone who has had illness or injury that can be overcome with medicine, surgery or rest.
Some people will, eventually, move from cone 2 to cone 3, a transition that is irreversible. The transition is not usually abrupt, though it may be, with the scope of those allowed 'in' steadily reducing. For some people, right at the end, it is too much to have anyone left inside the cone.
I have found this model quite helpful as I have accompanied families during the end-stage of a loved one's illness. It has permitted me, quite often, to remain inside the cone longer than might otherwise have been possible. At other times it has meant accepting that I am excluded from the cone, even when that is hard to face.
Another book that informed my essay, way back when, was Sharing the Darkess by Sheila Cassidy published by Darton, Longman and Todd in 1988. In this book, Cassidy uses a set of of four sketches to illustrate the kinds of relationships that a sick, or dying, person may experience in their care setting. If I remember correctly (it is more than a decade since I read the book and I don't have it to hand to check), there are four increasingly deep and mutual relationships:
- the medical professional - a doctor, pictured in white coat and with a nurse who is passing a syringe, who has skills, drugs and procedures to offer. The personal level of interaction is, inevitably, minimal
- the clergyman (sic) - pictured in clerical collar and stole, holding a 'host'; he has a functional role and the tools of scripture and tradition. A more personal relationship, but still professional.
- a professional, pictured in 'mufti', who now has no professional tools, yet who retains the knowledge and experience gained over years. Counselling or pastoral care can be offered. (I think this image probably relates to a terminal diagnosis)
- human beings - pictured naked, stripped of all that training or experience can offer. They meet in shared vulnerability and have nothing to offer but themselves.
The idea being explored here is slightly different from the cones model, in that it, at least to a degree, considers the de-skilling and re-humanising of the professionals involved in palliative or terminal care. In other words, once you are allowed to remain inside the 'cone' of a very sick or dying person, you have to become more vulnerable yourself (in an appropriate way - you are still a professional) accepting that you don't have all the answers and can't make it all alright. At least that's what I think it was about - I could be wrong!
The challenge for medical and religious professionals alike is that sometimes we can't 'mend' what is broken, that this person is going to die, and that if we are privileged enough to be allowed to stay in that ever-narrowing cone, we must allow ourselves to be de-skilled. To sit in silence, holding the cooling, pale hand of a person who is nearing the door of eternity... that's both privilege and challenge.
Over the last year I have to varying degrees walked with a number of people as they, or their loved ones, have neared the door from life to eternity. Sometimes I was allowed into the cone, sometimes I was an outside observer; either is a valid place to be. As we draw closer to the autumn festivals of All Saints and All Souls (even if Bappies generally don't mark them) and even of Remembrance, it seems somehow fitting to reflect, if briefly, on how we best share the darkness, walking with otherws towards the door of eternity...