There was a time when we were told more often than we are today that "confession is good for the soul." As a spiritual directive that is still true, but being entrusted with someone's confession is dangerous. Hearing confession can remind one of certain failings or shortcomings of one's own, If not that, one might be compelled to unexpected feelings of sympathy, even embarrassment, by the other person's story. We will not be left unmoved.

Richard L. Morgan's "Confessions of a Pastoral Visitor" brought recollections of moments in my ministry that I would just as soon have left in memory's attic. He tells us frankly that there were times he lapsed into superficiality or pious cant on his rounds. Although I didn't want to admit it, there were times when I did the same. Caregiving that is genuinely beneficial for those who suffer illness demands an exquisite combination of skills along with a considerable store of physical energy. Given our human frailties, and in spite of our best intentions and the powerful resources of our faith traditions, we ministers do nor always succeed.

After having made hundreds of hospital and sickroom visits as a parish pastor for more than 33 years of my 42 years of ordained ministry, I, like Pastor Morgan, one day found myself on the receiving end of such ministrations. For several years, at the time of my annual physicals, the doctor had noted that there was something abnormal in the shape of my prostate gland. Soon after turning 60, I was advised to undergo a biopsy of the prostate, an unpleasant experience that revealed nothing alarming. Four years later, acting on what I can only say was an intuition, I asked my internist for another examination. This time the abnormality that had been noted before caused the internist to refer me to the urologist, who used a new tool now at his disposal—the prostate-specific antigen (PSA) test—plus some advanced ultrasound techniques and the performance of the biopsy.

"Reverend Koenig, your test results came back. You will have to tell me what your choice is in the way of treatment," he said over the telephone as I was eating dinner. "Treatment for what?" I asked naively, having forgotten (suppressed) the reason I had made the trips to the hospital a month before. Somehow I imagined that having undergone the inconveniences involved in the biopsy, the problem had been dealt with. There was no problem. There could be no problem. But there was. "You have cancer, Reverend Koenig," the doctor said in the faintly weary tone that people use when speaking to those who don't get it. "Let's talk things over in the office on Monday." "Thank you, doctor," I replied, already adopting the submissive posture of the patient anxious to please the (imaginedly) omnipotent and omniscient individual who from that moment on would carry my life in his hands.

My hand shook as I signed the consent form for a radical prostatectomy, "the most thorough choice," I was told, to "cure" me of cancer. It seemed that I was one of the fortunate 15 or 20 percent of men diagnosed with cancer of the prostate who were able to make surgery their therapy of choice. The cancer was encapsulated, only a nodule poking up in a location that would make it a good bet that the surgeon would "get" everything. "If you are going to get cancer, this is the best type to get," so one of the doctors said gaily at one point. I was momentarily relieved. Even so, the possibility of urinary incontinence and permanent impotence from the surgery was tough to face. At the same time, the prospect of the cancer "racing through my body," as I envisioned it would, was equally tough. All I could think of was to have the damn thing out and out fast. I'd deal with whatever other problems turned up once my feet were firmly planted on the road of life again.

There are several ways a radical prostatectomy can be performed, all of them barbaric, it seems to me. Drastic measures are necessary because of the inconvenient location of the gland. The day before the scheduled surgery, I packed my bag and took the commuter line to the Boston hospital where the operation was to be performed. I had told my wife not to accompany me since the things I had to do pre-op were best done in private. Alone in my room on the seventh floor of the hospital, between trips to the bathroom to clean out my insides, as I had been instructed, I watched the city's lights come on. The dullness of the overcast day that was ending made them seem even brighter than usual. Each light signaled happy human activity of one kind or another—someone going out to dinner, another working late at the office, people shopping, others heading to the symphony or theater, everyone enjoying casual good health. Already I had started to feel the isolation of the ill from the rest of humanity.

The surgeon entered my room accompanied by his young nurse, whose friendliness and encouragement I had come to value as I prepared myself for the operation. I was pleased, in a crazy way even proud, to be able to report that I was expelling only clear liquid by that time. No sign of the approbation I was looking for from the surgeon at the beginning of our adventure together, but the achievement was noted. He left without saying anything that sticks in my mind as encouraging, although I am sure his parting words were meant to convey something of that sort. It was just that my feeling of isolation, sadness, self-pity, and a silent, pervasive fear made it hard for me to hear anything.

Then my chaplain arrived. In the three months since I'd received the test results (the operation was, maddeningly, twice postponed), I had constantly sought information on what I had, what I would undergo, and what might eventuate. Looking back, I fought "as one who beateth the air," in the King James voice of St. Paul describing one who engages in a futile struggle against a spiritual foe. But one decision I did make that turned out to be of enormous help to me was to choose a personal chaplain.

Who the pastor's pastor should be has long been a subject of debate in the profession. The individual I asked to be my pastor in angustiis, the "narrow straits" I was to pass through, was a trusted friend and colleague who served as pastor of a neighboring congregation. Fastidiously dressed, as usual, in black clerical garb that accented the whiteness of his carefully trimmed goatee, his arrival immediately dispelled my feelings of isolation. After some cheerful exchanges, he arranged the vessels for Holy Communion on the table beside the bed and read the service for me. I received the bread and the tiny sip of wine gratefully. At the end of the Liturgy, my friend put his hand on my forehead and pronounced the blessing.

The feeling of peace that enveloped me is as real today as the memory of the operation itself. I felt whole once again, connected with fellow human beings, fellow believers. I felt like a person, someone with a name, an identity that had been all but lost in the bewilderment attending the diagnosis, the process of admittance, the pre-op procedures, the emptying of my bowels, the loneliness of the solitary room where I was to spend the night, the formidable journey on which I was to embark the next morning. It was a gift that I would have to reclaim and deepen in meeting what lay ahead.

I do not know what Pastor Dan Carlson was feeling as he read the service. Perhaps he was tired. Perhaps he wanted to be at home with his family. Perhaps he had five other people he had to visit after me. But whatever his feelings, his ministrations lifted my soul and enabled me to endure what turned out to be as trying an ordeal as others had predicted and I had speculated that it would be.

I dare to believe that my experience might afford encouragement and comfort to all who offer spiritual and emotional care to those who are ill. We might judge our gestures inadequate and superficial. Our words might sound in our ears like cant at times. But the ill, while not lacking in critical discernment, are not put off by our shortcomings. Loving intentions allow them to take words, gestures, and rites that are larger than their bearers at face value. Spirits are lifted. When the traditional words of the Lutheran Liturgy were read, they possessed a life and power of their own. The texts and the rites spoke to me in ways that I now realized I had only vaguely comprehended when administering them to others. The love both human and divine that met me in my distress proved as important as any of the antibiotics I was given for my healing. (At this point I must acknowledge that my wife, Elaine, was and continues to be a principal source of that love.)

Pastor Morgan reports that he was close to death from hemorrhaging following prostate surgery. The experience bred some disillusionment with the medical profession and became a time of soul searching and spiritual testing. To our joy and relief, his story ends on a triumphant note. The "darkness of illness" became the venue in which a "strange new Presence" appeared. The pastoral visitor was perfected in his calling as a result of his experience. He learned, he said, "how to be a caring presence to others."

In a broadcast over National Public Radio recently, an interviewer remarked that after talking with people who have passed through some medical ordeal, the statement "illness can make you a better person" sounded to her almost like a cliché. To which I would answer, it may sound that way, but for those of us who have endured a major procedure for some life-threatening condition, it is anything but that.

While "illness can make you a better person," that outcome is not a foregone conclusion. A moment's reflection on the experiences of friends and relatives who have fallen seriously ill would, I think, reveal any number of cases where the afflicted person was not made "better" morally or spiritually, where life became embittered, even despairing, or where the ill person simply scrambled to put the experience behind him or her as far and as quickly as possible.

That certain people feel that they have been made better persons after an encounter with life-threatening illness some would say is a tribute to the human spirit, others, a signal instance of the grace of God. Whatever its source, the mere frequency with which a beneficent outcome is reported following such an event is a phenomenon worthy of appraisal. In Pastor Morgan's case the spiritual advance that came about by virtue of his passage through the "dark night of the soul" was so pronounced as to lead him, as we have seen, to regard his previous ministrations as a pastoral visitor woefully inadequate, an exaggeration, I am sure. But his story evidences the life-transforming effect that often issues from the encounter with life-threatening illness.

I, too, have come to a different place in my spiritual journey in the wake of the surgery and what followed. I underwent the operation convinced, as I had been told, that I would be "cured" of cancer. The issue seemed quite simple: have the operation and then get on with life free from the specter of an unpleasant and early death. Looking at the actuarial tables, I figured, like a gambler at the blackjack table, that I would be adding about 10 years to my life with this move. Of course there would be sacrifices, but I would take them in stride. The main thing was to live.

I underestimated the sacrifices. Nothing that had been told me about a radical prostatectomy prepared me for the discomfort I would experience in getting my bowels to move again, or having to use a catheter for ten days after surgery to drain my bladder, or suffering from hemorrhoids brought on by an infection from clostridium difficile (a "hospital bug" known as "c-dif" by the staff) that leaves one weak from diarrhea. Most serious of all, however, was coming to terms with an impotence that would prove permanent.

Judging from what has been determined regarding the sexual activity of married couples, I suppose that my wife and I enjoyed a normally active sex life. While we never considered it sine qua non, our sexual life was an enjoyable and precious bond between us. Even at our stage in life, when the frequency of sexual intercourse is much less than at first, the loss of the ability to engage in normal sexual activity created a void. Something has gone from our life together than cannot be replaced.

Cancer is a formidable foe. Even with highly sophisticated equipment and advanced techniques, it can elude eradication—quite literally. A year after the prostatectomy, measurable amounts of PSA began to show up on my screening rests, meaning that some of the tumor tissue was still active. "They tried for the home run, but they missed," a doctor friend told me. "But we are 85 to 90 percent sure we can catch this by radiation," so the radiologist said. Six months after 35 treatments in the bomb-shelter-type quarters where radiation is administered, my PSA ominously began to rise again. So much for predictions, so much for percentages.

The turning point in Pastor Morgan's story comes at his discovery of "a strange new Presence" in his time of abandonment. Mine came in a fresh realization that I was not a statistic, but a person, that my destiny was not in the hands of some kind of blind physiological process that will work its way out one way or another, but in the keeping of Someone to whom I mattered and to whom I could entrust myself in confidence-and with whom I could argue, if need be. The shattering of my reliance on the physicians' prognosis opened the way for me to claim and deepen what Pastor Carlson's blessing before the surgery had given me, a sense of personhood growing out of an awareness of the divine presence and care that transcended whatever was happening to my body.

The bird of mortality, as someone put it, had come to sit on my shoulder. It has not left. It never will. But instead of inducing depression or despair, the bird's presence has generated a new appreciation of life, "sweet life" as Homer calls it all the time in the Iliad. The possibilities that each new day presents seem to stand out in bold relief before my imagination. At the close of each day, whether I have been engaged in recreation or creation, activities trivial or more substantial, I feel a deep sense of satisfaction for just having been. The uncertain future that, humanly speaking, seems to be what I am facing has engendered new energies for the various opportunities for ministry that come my way even as a retired pastor.

If I ask myself why this happened, I think it is that accepting mortality clears the mental eye to discern the grace with which one's life has been crammed. Careening forward compulsively in our careers and professions, we simply do not have the capacity to appreciate the pattern and texture of our lives. Nor is it easy, despite the accomplishments we register, to see life as much more than a Sisyphean effort. Its ultimate meaning remains a mystery. The bird of mortality on the shoulder makes one look at things from a different angle. The feeling, whatever has been, is of completeness. The illusions created by the futile attempt to quantify life are blown away. One is liberated from preoccupation with the self and its accomplishments (so necessary for our feelings of worth) to love.

The realization that omnipotence and omniscience remain attributes of God and not of physicians actually made me appreciate doctors in a new way. Highly trained and dedicated to helping the ill, they are limited by their sciences, not to mention their own personal temperaments and abilities. In addition, they operate under intense pressures imposed upon them by their patients' anxieties and ofttimes absurd expectations. Then there are so many of us. Where does the doctor find the resources to deal with the sea of emotions as well as the serious medical problems that we bring? If it is asked who is the pastor for the pastor, I wonder who is the "pastor" to the physician in his or her calling?

Falling ill with a serious disease is a vortex that can pull one into the self while all others disappear from sight. The suction is anxiety, but amazingly, as I have recounted, when what one considers the worst happens, the waters grow more calm. Having fended off the symptoms of advanced prostate cancer at least for a time by means of the best treatments known to medical science, I felt like a Holocaust survivor, bewildered by the magnitude and the cost of the efforts to extend my life and wondering why I was spared. I began musing about what happens to people who are the main breadwinners for their families or fill other important roles but go untreated simply because they aren't covered—as I was—by private medical insurance. Even before President Clinton was elected and put forth his proposal, I had become committed for moral reasons to the principle of universal health coverage. As one writer put it, I did not want the treatments that I had and continue to have "to be a privilege based on my occupation or income. If cancer occurs without prejudice, its treatment should be available without prejudice as well."

In 1956 Dag Hammarskjöld wrote in Markings, in his usual oblique style, this:

Beyond obedience, its attention fixed on the goal—freedom from fear.
Beyond fear—openness to life.
And beyond that—love.

Surely it is possible to discover this for oneself in ways other than coming face to face with death through an illness, some grave condition, or medical procedure. It probably was so for Hammarskjöld. For me, however, that was the way my journey led and continues. I think I can say, like Pastor Morgan, yes, the experience has made me a better believer and a better human being. And as the others have said, too, in a paradoxical way I am grateful for it.

Richard F. Koenig is a retired Evangelical Lutheran Church in America pastor.