In the almost fifty years since I graduated from medical school I've seen a thousand cartoons depicting the bedside manner of the doctor. They're funny because they often catch hold of a profound truth in a lively, comical way.

But you pastors shouldn't laugh too hard! If you do any visiting and counseling in the sick room, you must learn the same hard lessons — and bear up under the same jokes. You too must adopt a very special bedside manner when you approach the bedside of an ill patient.

Before getting down to specifics, may I make an observation which at first will seem obvious, even unnecessary, but which on closer thought is not only very complicated and intricate but germane. It's just this: when you enter a patient's room, you should remember that you are the patient's pastor, and then everything else will flow naturally from that attitude.

Let me illustrate. In Swahili, which I learned as a missionary in East Africa, I noted with interest that the word for pastor in mchungaji. Mchungaji means shepherd. And the noun derives directly from the verb kuchunga, which means "to protect," or "to guard." The pastor is the guardian of his flock, the protector of his faith. If you will remember this, you can forget just about everything else.

In the sick room you must be a pastor in a very special way. But isn't this true of all the other things you do? You wouldn't go into a jail and counsel a teenager the same way you counsel a middle-aged matron with marital troubles. So you must tailor your approach to each individual patient.

For the young man who has had a hernia operation or the young woman who has had a cancer-negative biopsy, you will have little trouble. But your role is vastly different in the case of a patient of any age who is in the hospital with a serious illness. It is a role to be learned — but not a role to be feared.

And many of you do fear it. I know this because your faces and your body language tell me. You feel out of your element. You see that the doctors and the nurses are completely at home in the hospital. You are at home in the pulpit, in your study counseling, in the home of a parishioner. But you are on foreign territory in the hospital, dealing with an individual who may have not only mental, emotional and religious problems, but also a serious physical illness.

So to you young pastors still struggling with the fears of visiting the very ill patient 1 say: Admit it, don't be ashamed of it, because you have lots of company. Study yourself to see just where those fears are the greatest and tackle them as you would any other personal problem.

Now let's see if I can help you overcome those fears with some positive ideas. You know, I have an interest in what you do and say. The patient may be mine! When you minister to him you either come into conflict with my treatment or you augment it. The first thing you must do is to learn something about that patient's illness before you go in to see him. Often this is easy. Sometimes it's not, and then you must do a bit of research.

If you know his doctor and can talk to him, call and tell him of your concern. Or better yet, try to catch him on the ward. Because of his desire to honor the privileged communication between himself and his patient, he may be reticent to give you much information. He almost certainly will not want to give you a detailed run-down on the illness, surgery, etc. But he may give you an answer to a request put like this: "I'm going in to see Mr. Jones this afternoon, doctor. I know he's very ill, but what I don't know is just how ill. If I knew, I'd be better equipped to help him through his illness."

If this fails, call on the closest relatives. The spouse perhaps, or, if the patient is elderly, the children. You walk the razor's edge here: you can't afford to antagonize his doctor and relatives by appearing too inquisitive, but on the other hand you can't serve as his pastor unless you know what's going on.

Another source of information is the head nurse on the ward. Don't stop any nurse who happens to be walking by. Ask to speak to the head nurse, preferably in her ward office. Identify yourself. Tell her that anything she can tell you will be kept in strictest confidence.

Explain why you want to know. And then when she tells you, keep that information confidential. Build a reputation for yourself as a person who can be told things. I had a pastor once who actually talked about his parishioners' illnesses from the pulpit and/or in open meetings — not just that Mrs. Jones was sick and would appreciate visitors, but that she had hemorrhoids or had had an abortion or was dying of lung cancer from smoking too much. I never told that preacher anything about my patients.

You've done your homework, you've perhaps looked up some medical terms that were unfamiliar, and now you're ready to enter the sick room. What do you do and what do you say? First of all, be cheerful, but not overly frivolous, jovial or breezy. Don't overdo it. Some of you are like that by nature, and you're just going to have to tone yourself down a bit. The patient at this stage of his illness wants friendliness, he wants sincerity, and he wants warmth. He doesn't think being sick — at least to this extent — is the least bit funny. This is something many of us — including me — need to remember.

My present pastor recalls being in a hospital room when an extremely cheerful nurse bustled in, threw open the drapes and cried, "It's a wonderful day…" After she left, the patient said, "Doesn't she give a **** for how I might feel?" Now maybe the patient needed just that jolt, but he didn't think so. He wasn't ready for such open-handed cheerfulness.

Secondly, convince the patient by your actions that you have come just to see him. Don't stand peering at him from the end of the bed. Go to the side of the bed, lean forward, say hello, pull up a chair, and sit down. Take the patient's hand and hold onto it until you sense he wants to let go. No matter how long you stay, the patient will get the feeling that you have come just to see him and talk with him. All too often I've seen a pastor come in and just sort of stand around uncomfortably, anxious to get away and showing it.

Thirdly, if there is another patient in the room, ask him to leave: "Do you think you could take a walk for a few moments?" You cannot talk to a patient, person to person, about his illness and life and death, if strangers are present. If the other patient can't leave, pull the curtain across and try to shut him out by pretending you're in your own little room. Perhaps your patient can't, and then you have a problem for which I can't give you a ready solution.

Fourthly, I think it's important to even ask relatives to leave, with the possible exception of a spouse or a very close adult child. Not every time, but on those occasions when you feel some very profound discussions may take place. Often you'll find visitors are just on the verge of going, anyway. They find it difficult to come in at all, and will stay as long as propriety dictates and then get away as soon as feasible. I know this is true because it happens to me all the time. Now the room is cleared, you have the patient's attention, and you're ready. First, let's look at some things you won't say.

Try to fend off questions of a medical nature. Perhaps the patient is an old friend or a long-time parishioner, and you do know him and his illness well enough to give answers to those questions. But I think you'll have trouble eventually if you do it routinely. In most cases you should say something like this: "Well, yes, the doctor told me such and such, but you'd better ask him." If he's having trouble talking to his doctor — a not uncommon problem and usually the doctor's fault — perhaps you should talk to the doctor and tell him Mr. Jones really is anxious about upcoming tests or surgery.

Never indicate to the patient less than total faith in his doctor. To do otherwise is just devastating. This may be tough if you've heard uncomplimentary things about that doctor. But always remember that what you have heard is hearsay and may well be untrue. If you really question a doctor's care, what can you do? The best thing is to suggest to the family a consultation with another doctor. You're dealing with the doctor's pride, it's true, and you may wound it, but I consider this a minor thing compared to having the patient and family feel insecure.

Don't use unjustified statements to the patient as you leave: "So long, Bob, everything is going to just fine," and other clichés. Maybe you don't mean to sound indifferent, but the patient may interpret it that way because he may know that he isn't going to be just fine.

So what are you going to say to a very ill, perhaps dying patient? I won't be presumptuous and put precise words in your mouth. But as a concerned layman rather than as a doctor, and somewhat hesitantly, I offer the following.

Remember, first of all, that you are this patient's pastor, his shepherd. He doesn't regard you as just another visitor who dropped in to talk about last night's football game. You are his pastor. You are a special type of visitor and at the same time a part of the hospital team.

When you talk to a patient at this stage of his illness, please don't blunt your faith with platitudes. Oh, yes, use your Bible, or whatever other source you want. And use prayer to bring the patient closer to God and God closer to the patient, but don't blunt his faith with platitudes. You should not use words which somebody else has said — no matter how great they might be — except as a means of getting into or out of the conversation. Use your own words, because the very ill patient wants to hear something directly from you — and platitudes are not enough.

So, pastor, please, when you're visiting a seriously ill patient, be yourself, be true to yourself, do your homework, sit down with the patient in private, talk to him of his faith and yours, shore up his insecurity, be honest with him. And remember first and last that you are his pastor, his shepherd.

Give a bit of thought to these suggestions and I think you'll find that they'll help you come closer to the ideal of the Good Shepherd.


Birney Dibble is a physician that practices in Eau Claire, WI.

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